Laparoscopic Adjustable Silicone Gastric Banding Research Articles

The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity.

Morbid obesity is effectively treated by restrictive surgery. A severe complication associated with gastric banding is gastric erosion. We review here our experience over a 5-year period. A total of 1496 patients underwent gastric banding. Eighty-five percent of patients were available for follow-up. When band erosion was diagnosed, laparoscopic removal was performed. Band erosion was identified in 17 patients (1.13%). The time from primary operation to diagnosis of band erosion ranged from 3 weeks to 45 months (mean, 19 months). Clinical manifestations included weight gain in 2 (11.6%), band system leak in 1 (5.8%), chronic port-cutaneous fistula in 2 (11.6%), neglected peritonitis in 1 (5.8%), left subphrenic abscess in 2 (11.6%), but most commonly, protracted port-site infection that occurred in 7 patients (40.6%). Patients were effectively treated by band removal and suturing of the stomach wall. We suggest that different pathologies contribute to the same complication depending upon the time of presentation. We recommend a high index of suspicion in order to diagnose this life-threatening complication.

Early carotid atherosclerosis in normotensive severe obese premenopausal women with low DHEA(S).

The aim of this study was to investigate the direct involvement of hyperinsulinaemia, DHEA and DHEA-S [DHEA(S)] in severe obesity in early carotid atherosclerosis, measured as intima-media thickness (IMT). Seventeen normotensive premenopausal women with very high BMI (43.5 +/- 1.6 kg/m2) were recruited for the study. Six women were also evaluated 12 months after laparoscopic adjustable silicone gastric banding (LASGB). Dietary intake, fasting plasma lipid profile, glycemic and insulinemic response to the OGTT, adrenal secretion, at baseline and after ACTH stimulation test, were measured. IMT, common carotid diameter (CD) and left ventricular mass index (LVMi) were measured by B-mode echotomography. All obese subjects showed higher fasting and stimulated insulin levels, but lower DHEA(S) levels than controls, showing a negative correlation between both fasting and stimulated insulin and DHEA(S), either at baseline or after ACTH testing. IMT was higher (p < 0.05) than controls, with a positive correlation with stimulated insulin (p < 0.05) and a strong negative correlation with DHEA(S) (p < 0.001). In a multiple linear regression analysis, insulin response to OGTT maintained an association with DHEA(S) independent of fasting insulin, while DHEA maintained the association with IMT independent of stimulated insulin (p < 0.0001). In the six patients evaluated 12 months after LASGB, fasting insulin levels decreased, while DHEA(S) levels increased (p < 0.05). In conclusion, an early cardiovascular involvement was detected in this group of severe obese with hyperinsulinaemia and low DHEA(S), even in the absence of other well known CVD risk factors.

Our experience with 250 laparoscopic adjustable silicone gastric bandings.

In 1999, after having performed more than 2500 open bariatric surgery procedures, we began to conduct the laparoscopic adjustable silicone gastric banding (LASGB) procedure. The purpose of this report is to present the results of our first 250 operations using this technique. The 250 patients included 212 females and 38 males. The mean age was 36 years (range, 16-62). The mean BMI was 44 (range, 35-76). Patients were selected in accordance with standard criteria. The mean follow-up time was 18 months (range, 3-24). Two hundred and forty procedures were completed by laparoscopy; conversion to open surgery was required in 10 cases. The mean operating time was 50 min (range, 20-145). There was no mortality. Perioperative complications included two cases of gastric perforation. Late complications included 13 cases of band slippage (5%), of which three involved penetration to the stomach, five cases of port disconnection (2%), and four cases of port site infection (1.5%). The mean weight loss at 12 months was 70% of the original excess weight. Most patients prefer laparoscopy as the surgical technique in the treatment of morbid obesity. Our initial experience with 250 operations confirms that this approach is as good as open surgery. The long learning curve is steep, requiring at least 100 cases to guarantee low complication rates.

Complicação da banda gástrica ajustável videolaparoscópica para tratamento da obesidade mórbida: extrusão da banda

Various options for surgical treatment of morbid obesity have been developed with varying results: vertical banded gastroplasty with intestinal by-pass, disabsorptive surgeries and laparoscopic adjustable gastric banding. Although all of them have been effective in weight loss, lower rates of early and late postoperative complications have been described in some procedures. Laparoscopic adjustable silicone gastric banding (LASGB) has a similar principle as vertical banded gastroplasty and it is a minimally invasive procedure, with low systemic and operative problems, but not free of them. We report two rare cases of this complications of LASGB.

Laparoscopic gastric banding in morbidly obese adolescents.

4% of adolescents in the U.S.A. are obese, 80% of whom will become obese adults. Obesity in adolescence is associated with increased mortality and morbidity in adulthood. Is laparoscopic adjustable silicone gastric banding a safe and effective method of weight loss in morbidly obese adolescents? Since 1996, data has been prospectively collected on all patients undergoing laparoscopic adjustable gastric banding (LAGB) by a single surgeon. Patients are reviewed at 6 and 12 weeks following surgery, then at 3 monthly intervals. Weight loss is measured in absolute terms, reduction in body mass index (BMI) and as percentage of excess weight loss. 17 patients with a median age of 17 (12 to 19) years underwent LAGB. Median follow-up was 25 (12 to 46) months. 2 complications occurred, 1 slipped band and 1 leaking port. BMI fell from a preoperative median of 44.7 to 30.2 kg/m2 at 24 months following surgery, corresponding to a median loss of 35.6 kg or 59.3% of excess weight. 13 of 17 patients (76.5%) lost at least 50% of their excess weight, and 9 of 11 patients (81.8%) had a BMI < 35 kg/m2 at 24 months following surgery. LAGB is a safe and effective method of weight loss in morbidly obese adolescents, at least in the medium term. Its role in preventing obesity and obesity-related disease in adulthood remains to be determined as part of our long-term study.

Experience with Lap-band System up to 7 years.

Morbid obesity occurs in 2-5% of the population of Western countries. Laparoscopic adjustable silicone gastric banding was designed to be a minimally invasive, adjustable and reversible procedure for the treatment of morbid obesity. The Lap-band System was evaluated retrospectively in a series of 543 patients. Data on preoperative aspects and postoperative outcome and weight loss patterns at up to 7 years follow-up (median follow-up 36 months) are presented. The most important late complication was total and irreversible food intolerance due to proximal pouch dilatation, which occurred in 24 patients (4.6%). 20 of these patients (3.8%) had had a proximal pouch calibration with 25 cc; 4 patients were calibrated with 15 cc. The mean BMI had fallen from 44 kg/m2 to 33.2 kg/m2 and was stable after a follow-up of up to 86 months (median 36 months). The Lap-band System is an effective procedure for achieving appreciable and stable weight loss at up to 7 years of follow-up (median 36 months). The minimally invasive approach was associated with a short hospital stay and a low rate of complications. Preoperative patient selection, detailed information and availability of the multidisciplinary team permitted us to achieve good longstanding results.

Disruption of the leptin-insulin relationship in obese men 24 hours after laparoscopic adjustable silicone gastric banding.

The placement of a band to attain a tiny stomach pouch has been reported to produce early satiety in patients undergoing gastric banding. The adipocyte-derived hormone, leptin, has been shown to decrease both food intake and body weight. The aim of the present study was to assess the potential involvement of acute changes in leptin concentrations following laparoscopic adjustable silicone gastric banding (LASGB). The study groups comprised obese male patients undergoing bariatric surgery by LASGB and overweight men undergoing laparoscopic Nissen fundoplication (NFd). Blood was drawn before surgery and 24 hours postoperatively for glucose, insulin and leptin measurements. In both experimental groups, a statistically significant decrease was observed in pre- and postsurgery glucose (LASGB 111 +/- 8 vs 99 +/- 6 mg/dl, P < 0.01; NFd 107 +/- 7 vs 98 +/- 5 mg/d, P < 0.01) and insulin concentrations (LASGB 39.8 +/- 11.9 vs 32.9 +/- 10.3 U/l, P < 0.01; NFd 13.2 +/- 3.3 vs 12.2 +/- 2.9 U/l, P < 0.05). However, no significant differences were observed when the percent change from pre-surgery values was analysed between both groups. Following surgery, an increase in leptin concentrations was observed in the LASGB group (23.5 +/- 4.7 vs 37.5 +/- 6.8 micrograms/l, P < 0.001) whereas a small decrease was evident in the NFd patients (12.9 +/- 4.6 vs 8.9 +/- 2.2 micrograms/l, P < 0.01). These findings strongly suggest that the short-term increase observed in plasma leptin concentrations following LASGB may play a key role in triggering an early satiety signal due to the modification of the gastrointestinal anatomy and physiology.

Laparoscopic Adjustable Gastric Banding

The introduction of laparoscopic adjustable silicone gastric banding (LASGB) has recently revolutionized gastric restrictive procedures in the treatment of morbid obesity. We analysed the short and long term results of this minimally invasive bariatric procedure. A total of 652 patients with a body mass of (median) 45 kg/m(2) were treated. There were only minor preoperative incidents. One patient died more than one month after the procedure. Early postoperative complications included 2 gastric perforations caused by a nasogastric tube and one early slipping of the band. Late complications occurred in 7% of the patients: 25 patients suffered a pouch dilation, 2 patients had gastric erosion by the band; 18 patients had port complications requiring reoperation. Loss of excess weight was 62% at 2 years. Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. The most frequent complication is pouch dilation. Further study is warranted for the evaluation of long term results.

A technique for prevention of port complications after laparoscopic adjustable silicone gastric banding.

Laparoscopic adjustable gastric banding is a safe and effective treatment method for morbid obesity. Injection port dislocation, tube perforation and access port infection are generally classified among the minor complications, although they can require a reoperation at the port-site or even at the level of the band which may have to be removed. We designed a technique to fix the port, that can avoid unnecessary complications. The port is sutured onto a polyprophlene mesh, which is then cut into shape and attached to the rectus fascia in the left hypochondrium with a Tacker stapling device. From February 2000 to January 2001, 25 patients (BMI 35-60) were operated using this technique. No injection port dislocation, tube perforation or access port infection has been found in these patients. With the larger surface area by which the port is attached to the fascia, a stable position of the port is obtained and dislocation avoided. Multiple failed attempts at port access, with resulting risk of infection, are avoided. Due to port stability, risk of incidental tube perforation is reduced. Moreover, a considerable gain of time is obtained compared with the classical suturing of the port.

Modifications of Metabolic and Cardiovascular Risk Factors after Weight Loss Induced by Laparoscopic Gastric Banding

The well-known inverse relation between life expectancy and BMI, particularly in morbid obesity, is presumably in large part due to multiple cardiovascular and metabolic comorbidities. Severely obese patients treated with laparoscopic adjustable silicone gastric banding (LASGB) were evaluated for such risk factors before and 1 year after LASGB. 130 individuals (age 20-66, BMI 34-59 kg/m2) who underwent LASGB between 1996 and 2000 were studied; 50 of them were available for reevaluation 12 months after surgery. The presence and severity of diabetes (DM), hypertension (HTN), hypercholesterolemia (HC) and hypertriglyceridemia (HT) were assessed before and after surgery. In 18 of them erythrocyte sedimentation rate (ESR) were also measured. Comorbidities were highly prevalent at the initial evaluation: DM 10%, HTN 32%, HC 37%, HT 27%. In the subgroup reevaluated after surgery, prevalence of DM decreased from 15% to 6%, HTN from 37% to 25%, HC from 36% to 25%, and HT from 29% to 13%, with an average BMI loss from 44.1 to 35.9. ESR decreased from a preoperative value of 36.7 +/- 22.6 mm/hr to 18.3 +/- 11.9 mm/hr at 1 year (p < 0.001). Morbidly obese subjects respond to LASGB with an impressive reduction of comorbidities which is sustained for at least 1 year, well after the initial acute negative energy balance and when weight tends to stabilize. The high prevalence of elevated ESR, which has been considered a strong predictor of coronary mortality, confirms previous reports of its association with obesity, and the clear tendency to normalization with weight loss may represent a further element contributing to lower morbidity.

Evidence-based medicine: open and laparoscopic bariatric surgery

The aim of this study was to perform an evidence-based analysis of the literature on open and laparoscopic surgery for morbid obesity. Human studies on surgery for morbid obesity were conducted. Multiple publications of the same studies, abstracts, and case reports were reviewed. Current Contents, MEDLINE, EMBASE, and Cochrane Library databases were investigated. Open Roux-en-Y gastric by pass (RYGB) for morbidly obese patients and long-limb RYGB for superobese patients are highly effective procedures. Randomized controlled trials comparing malabsorptive procedures with other bariatric operations are needed. The long-term efficacy of adjustable silicone gastric banding (ASGB) still is undetermined because of poor evidence. Laparoscopic RYGB is as safe as its open counterpart, although its long-term results are lacking. Laparoscopic ASGB is less invasive than open ASGB, although its efficacy cannot be determined because of poor evidence. Laparoscopic vertical banded gastroplasty (VBG) is becoming unpopular since the decreasing trend of open VBG. Laparoscopic biliopancreatic diversion with duodenal switch is feasible, but needs further studies. Randomized controlled trials comparing the various laparoscopic operations are strongly needed.

Laparoscopic adjustable silicone gastric banding for morbid obesity: results and complications in 715 patients.

Laparoscopic adjustable silicone gastric banding (LASGB) was used as the initial bariatric procedure for more than 36 months. The efficacy and safety of LASGB were studied. Patients were followed up prospectively in a multidisciplinary center for the perioperative and long-term courses, and for complications. Between November 1996 and May 1999, 715 patients underwent surgery. The mean age was 34.6 years (range, 16-72) years, and the mean body mass index (BMI) was 43.1 kg/m2 (range, 35-66 kg/m2). The mean operative time was 78 min (range, 36-165 min), and the postoperative hospitalization time was 1.2 days (range, 1-8 days). There were six intraoperative complications (0.8%), eight early postoperative complications (1.1%), and no deaths. For follow-up evaluation, 614 patients (86%) were available. Late complications included band slippage or pouch dilation in 53 patients (7.4%), band erosion in 3 patients, and port complications in 18 patients. In 57(7.9%) patients, 69 major reoperations were performed. In patients with a follow-up period longer than 24 months, the average BMI dropped from 43.3 kg/m2 (range, 35-66 kg/m2) to 32.1 kg/m2 (range, 21-45 kg/m2). Laparoscopic adjustable silicone gastric banding is safe, with a lower complication rate than any other bariatric procedure. Most reoperations can be performed laparoscopically with low morbidity and short hospitalizations. On the basis of intermediate-term follow-up evaluation, it is an effective procedure for weight-reducing purposes.

LAPAROSCOPIC ADJUSTABLE SILICONE GASTRIC BANDING

Laparoscopic adjustable silicone gastric banding (LASGB) is a relatively new surgical procedure for the treatment of morbid obesity The most popular banding procedure is the vertical banded gastroplasty, however, there are risks involved in this procedure, including staple-line disruption and postoperative intractable vomiting. This article presents the advantages of using the LASGB device over former types of gastric banding.

Laparoscopic adjustable silicone gastric banding: prospective evaluation of intragastric migration of the lap-band.

Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.

Laparoscopic Italian experience with the Lap-Band.

An increasing number of surgeons with different levels of experience with laparoscopic surgery and open obesity surgery have started to perform laparoscopic implantation of the Lap-Band. An electronic patient data sheet was created and was mailed and e-mailed to all surgeons performing laparoscopic adjustable silicone gastric banding (LASGB) in Italy. Patients were recruited since January 1996. Data on 1,265 Lap-Band System operated patients (258 M/1,007 F; mean BMI 44.1, range 27.0-78.1; mean age 38, range 17-74 years) were collected from 23 surgeons performing this operation. Intra-operative mortality was absent. Post-operative mortality was 0.55% (7 patients) for causes not specifically related to LASGB implantation. The laparotomic conversion rate was 1.7% (22 patients). LASGB related complications occurred in 143 patients (11.3%). Pouch dilatation was diagnosed in 65 (5.2%), and 28 (2.2%) of these underwent re-operation. Band erosion was observed in 24 patients (1.9%). Port or connecting tube-port complications occurred in 54 patients (4.2%), 12 of whom required revision under general anesthesia. Follow-up was obtained at 6, 12, 18, 24, 36 and 48 months, and mean BMI was respectively 38.4, 35.1, 33.1, 30.2, 32.1 and 31.5. The percentage of patients observed at each follow-up was > 60%. There was no intra-operative mortality and no complication-related mortality, with acceptable weight loss. The LASGB operation is safe and effective, and deserves wider use for treatment of morbid obesity.

A study of pain after laparoscopic gastric banding.

The introduction of the laparoscopic approach to bariatric surgery has brought similar advantages as those seen in general surgery. There have been no trials assessing postoperative pain after laparoscopic adjustable silicone gastric banding (LASGB). We compared prospectively postoperative pain and outcome in LASGB and laparoscopic cholecystectomy (LC), to determine if morbidly obese patients can expect the same benefits from a laparoscopic approach in gastric banding as those which are known for LC in non-obese and obese patients. In a prospectively collected database of 80 patients undergoing LASGB, information including a survey assessing the postoperative pain, the amount of analgetic drugs used, operative reports, laboratory data, and follow-up data was collected. This was compared to an equal number of patients undergoing LC. Postoperatively, all patients received standardized pain medication of 150 mg tramadol per day. Pain was assessed twice on postoperative days 1-3 using a patient questionnaire. Patient characteristics and duration of hospital stay were similar in the two groups. Although there was no significant difference in type and intensity of pain experienced by the patients in either group, the gastric banding patients reported less postoperative pain overall than those in the LC group. The analyzed data show that LASGB offers the same advantages as other laparoscopic operations, in that it induces less pain and enables the patient to return quickly to normal activity and work. The advantage over the compared LC group may be due to higher patient motivation, but was not statistically significant.

Laparoscopic Management of Lap-Band® Erosion

Laparoscopic adjustable silicone gastric banding (LASGB) is the bariatric operation of choice in our institution for most morbidly obese patients. The advantage of LASGB is a minimally invasive procedure, with low systemic and operative complication rates. However this procedure is not free from significant postoperative problems that may arise at a later stage. 950 patients underwent LASGB between November 1996 and May 2000, with a median follow-up of 21 months. 3 patients (0.31%), developed band erosion 6 to 8 months following the original procedure. Laparoscopic band removal was attempted in all 3 patients. The charts of all patients were reviewed for the postoperative course of the original operation as well as the removal of the band. 2 patients presented with abscess formation at the port site, and 1 patient suffered from a gastric fistula at the port site 6 months following surgery. In all patients the immediate postoperative course was not smooth; 2 patients developed a subphrenic collection drained percutaneously, and one patient had fever, treated empirically with intravenous antibiotics. In all 3 patients, no leak was demonstrated by CT and barium meal. The diagnosis of band erosion was confirmed by gastroscopy, which demonstrated part of the band eroding through the gastric wall. All patients were operated laparoscopically. The band was removed and the gastric wall was sutured. The postoperative course was uneventful and patients left the hospital within 3 days. LapBand erosion following LASGB is very rare and may occur months following the operation. The postoperative course suggests that the erosion is the consequence of a minute stomach wall injury during the primary operation. Diagnosis is essential and the treatment of choice is laparoscopic band removal with suturing of the stomach wall. It is possible that a minute injury to the gastric wall during the initial procedure is the underlying cause of this complication.

Resolution of chronic medical conditions after laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity in the elderly.

The routine cutoff age of surgery for morbid obesity is 55 years. A minimally invasive surgical approach, however, may enable its safe use in older individuals. Laparoscopic adjustable silicon gastric banding (LASGB) was performed in 18 patients 60 years or older. The perioperative course, early and late complications, and long-term follow-up all were recorded. Of 398 patients who underwent LASBG until November 1998 (mean age, 38.1 years), 18 were 60 years or older (mean, 63.6 years). The mean body mass index (BMI) was 44.4 (range, 35-64.7). There were no intraoperative complications. However, four patients had late complications requiring reoperation. The mean operative time was 65 min; the mean hospital stay was 1.3 days; and the mean follow-up period was 21.9 months. The BMI dropped from 44.2 to 30.5, and all comorbid conditions improved markedly: Diabetes mellitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 100%. According to the findings from this study, LASGB is feasible, safe, and effective in the elderly, and most benefit from resolution or marked improvement of comorbid conditions.

Egyptian experience in laparoscopic adjustable gastric banding (technique, complications and intermediate results).

Surgery can provide effective long-term treatment for morbid obesity. The purpose of this study is to present an Egyptian experience of laparoscopic adjustable silicone gastric banding (LASGB) as a safe and effective treatment. 108 morbidly obese patients having body mass index (BMI) > 40 kg/m2 were studied. 26 patients had a BMI > 50 kg/m2 and < 60 kg/m2, while 21 patients had a BMI > or = 60 kg/m2. The procedure was performed through a 4 or 5 trocar technique. Mean age was 32.3 years. Mean BMI was 48.9 kg/m2. All except two procedures were completed by laparoscopy. Mean hospital stay was 2.2 days. Mean BMI after 12 months was 37.2 kg/m2 and after 24 months was 34.3 kg/m2. Mean follow-up was 2.1 years and included 87 patients (81%). Complications included: gastric perforation (1), pleural injury (1), liver injury (1), port complications (6), periband sepsis (1) and slippage (3). There were no mortalities in this series. LASGB proved to be safe and effective for the treatment of morbid obesity in Egyptian patients.

The Epidemic of Severe Obesity: The Value of Surgical Treatment

The Epidemic of Severe Obesity: The Value of Surgical Treatment