Laparoscopic Vertical Banded Gastroplasty Research Articles

Laparoscopic Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Gives Better Result Compared to an Open Approach.

Vertical banded gastroplasty (VBG) has a relatively high failure rate in the long run, requiring revisional surgery in 30-65%. A common conversion option is to Roux-en-Y gastric bypass (RYGB), which can be performed laparoscopically or open. Current literature contains small cohorts and inconclusive results. Therefore, we set out to compare our series of open and laparoscopic VBG to RYGB conversions. All conversions performed between 1996 and 2020 were included. Patients were divided into 3 groups based on conversion indication: weight recurrence (group 1), excessive weight loss (group 2), and eating/pouch difficulties (group 3). The primary outcome was postoperative complications according to the Clavien-Dindo (CD) classification. Secondary outcome was %total weight loss (%TWL) 1 to 5 years after revisional surgery. We included 205 patients (84.9% female) of whom 105 underwent laparoscopic and 100 open VBG to RYGB conversion. Twenty-three short-term complications occurred in the laparoscopic group, with 16 > CD3a. In the open group, 33 complications occurred with 12 > CD3a. Overall complications were 33.3% in laparoscopic and 64% in open patients. There were no significant differences between the laparoscopic and open group in BMI (p = 0.76) and %TWL (p = 0.694) after 5 years. After 5 years, lost to follow-up was 97% in the open group. Twenty-eight percent of patients who reached follow-up in the laparoscopic group had available data. We demonstrate that the overall complication rate is lower in the laparoscopic group compared to the open group. Regarding BMI, an improvement was achieved in both groups after 5 years.

Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials

AimsBariatric surgery (BS) is recommended for subjects with a Body Mass Index (BMI) over of 40 kg/m2 or with a BMI between 35 and 40 kg/m2 with obesity-related comorbidities. Aim of the study was to compare different types of BS with medical therapy (MT) for the treatment of obesity. Data synthesisWe conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different BS techniques versus MT in people with obesity, with a duration ≥24 weeks (PROSPERO, #CRD42020160359). Primary endpoint was BMI. Indirect comparisons of different types of surgery were performed by NMA. Types of BS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); Laparoscopic Vertical Banded Gastroplasty (LVBG) and duodenal switch (DS). 43 trials were retrieved in this metanalysis. BS was associated with a significant reduction in BMI, systolic blood pressure, triglyceride and fasting glucose, and with a significant increase of HDL cholesterol when compared to MT. In direct comparisons, RYGB was more effective than LAGB, LVBG, and GCP, but less effective than DS, whereas LAGB was less effective than LVBG and SG. In the NMA, DS and BPD appeared to be more effective than other procedures. ConclusionsBS produces a greater weight loss than MT in morbidly obese patients, inducing a greater improvement of obesity-associated metabolic parameters. Available data are insufficient to assess the effect of BS on mortality. Different surgical procedures are heterogeneous for efficacy and safety.

Bariatric Surgery Conversions at a Revisional Referral Center: A Subset Analysis of Clinical Outcomes from a Rural Community Hospital Accredited Program

Introduction: Revisional bariatric surgery for complications and weight regain is associated with higher morbidity and mortality rates compared to primary bariatric surgery. The majority of procedures are done in an urban setting. Methods: A retrospective chart review with IRB approval was conducted in a rural community hospital accredited bariatric program. A total of 53 revisions were performed by a single surgeon from February 2019 to February 2020. A subset analysis of 18 bariatric surgery conversions was performed and its outcomes are presented. Primary outcomes were 30-day morbidity and mortality. Secondary outcomes included anastomotic or staple line leak, intraabdominal abscess and need for subsequent surgery. Results: Most patients were female (83.3%) and the median ASA class was 3. The mean age was 48.2 ± 13.3 years. Most conversions were performed laparoscopically (88.9%), with a minority done robotically (11.1%). There were no open procedures or conversions to open. The most common prior bariatric operation was a sleeve gastrectomy (SG) (44.4%) followed by vertical banded gastroplasty (VBG) (22.2%). The most common type of operation was laparoscopic SG conversion to Roux-en-Y gastric bypass (RYGB) (16.7%) followed by laparoscopic VBG conversion to RYGB (16.7%). History of tobacco use was present in 38.9% of patients. The most common preoperative comorbidity was severe gastroesophageal reflux disease (GERD) (88.9%). The 30-day morbidity was 33.3% and there was no mortality. There were no anastomotic or staple line leaks. Intraabdominal abscess developed in 11.1% of patients. The rate of marginal ulceration was 27.8%, with only one case (5.6%) requiring future gastrojejunostomy revision. The rate of subsequent surgery beyond 30 days was 22.2%. Conclusion: With an acceptable complication rate, no anastomotic or staple line leaks, and no mortality, minimally invasive bariatric surgery conversions are feasible and safe in a rural community hospital environment, with the most common indication being complications from a prior laparoscopic SG, and with the RYGB being the most common procedure as an end product of conversion.

Conversion of both Versions of Vertical Banded Gastroplasty to Laparoscopic Roux-en-Y Gastric Bypass: Analysis of Short-term Outcomes.

Conversional bariatric surgery has relatively high rates of complications. We aimed to analyze our single-center experience with patients requiring conversional laparoscopic Roux-en-Y gastric bypass (LRYGB) following a failed primary open or laparoscopic vertical banded gastroplasty (OVBG or LVBG, respectively). The records of patients who underwent LRYGB as a conversional procedure after VBG between November 2004 and December 2017 were reviewed. Characteristics, body mass index (BMI), operation time, intraoperative problems, length of hospitalization, and early (< 30days) morbidity and mortality were analyzed. Data were expressed as mean ± standard deviation or frequency. A total of 329 patients (81.76% females) who underwent conversional RYGB were included. For the LVBG group (224 patients) and OVBG group (105 patients), respectively, BMI was 34.15 ± 6.38 and 37.79 ± 6.31kg/m2 (p < 0.05), the operation time was 96.00 ± 31.40 and 123.15 ± 40.26min (p < 0.05), hospitalization duration was 2.96 ± 1.13 and 3.20 ± 1.20days (p = 0.08), the early complication rate was 7.14 and 11.43% (p = 0.19), and the reoperation rate was 2.23 and 2.86% (p = 0.73). There were no major intraoperative problems. Three patients with OVBG were converted to open RYGB (2.86%). There was no mortality. The conversion of OVBG and LVBG to laparoscopic RYGB is technically feasible and provides comparably low early morbidity rates and length of hospitalization. However, compared to LVBG, conversional laparoscopic RYGB following OVBG is technically more challenging and time-consuming, with a slightly higher risk of conversion to open surgery. We support the use of such conversional bariatric surgery in specialized, high-volume bariatric centers.

Serum vaspin level as a predictive indicator in the amelioration of fatty liver and metabolic disturbance in patients with severe obesity after laparoscopic vertical banded gastroplasty.

Background:This study is all about predicting the value of serum vaspin level in the amelioration of fatty liver and metabolic disturbance in patients with severe obesity after laparoscopic vertical banded gastroplasty (LVBG).Methods:A total of 164 patients (from January 2012 to May 2015) with severe obesity were chosen and performed LVBG. Enzyme-linked immunosorbent assay was performed to detect the serum vaspin level. The patients were given a biochemical automatic analyzer to measure the biochemical indicators. Homeostasis model assessment (HOMA) helps in the calculation of fasting insulin level (FINS) and insulin resistance (IR). The changes in fatty liver were examined by computed tomography (CT). Receiver operating characteristic curve is used to increase the predictive value of serum vaspin level in the amelioration of liver function and disturbances in the metabolism.Results:Weight, BMI, waist circumference, serum vaspin level, and triglyceride (TG) decreased, but CT value of liver increased at 4th, 7th, and 12th month after surgery. After the 7th and 12th month period of surgery, the alanine aminotransferase, aspartate aminotransferase, FINS, and HOMA-IR reduced in the patients (P <.005). The area under ROC curve (AUC) is about 0.871 ± 0.031 with 95%CI of 0.810–0.931 (P <.001). The sensitivity, specificity, and accuracy of serum vaspin level ≤0.9 were 87.80%, 78.05%, and 83.28%, respectively. BMI, FINS, and serum vaspin level ≤0.9 were the influencing factors of the amelioration of fatty liver and metabolic disturbance.Conclusion:This study proves that the serum vaspin level serves as a predictive indicator in the amelioration of fatty liver and metabolic disturbance in patients with severe obesity after LVBG.

Ultrasound-guided single injection transversus abdominis plane block of isobaric bupivacaine with or without dexamethasone for bariatric patients undergoing laparoscopic vertical banded gastroplasty: a comparative study of different doses

Background Dexamethasone has anti-inflammatory properties that can prolong postoperative analgesia when added to isobaric bupivacaine transversus abdominis plane (TAP) block for bariatric patients undergoing laparoscopic vertical banded gastroplasty. Patients and methods A total of 111 bariatric patients, scheduled for laparoscopic vertical banded gastroplasty under ultrasound-guided TAP block, were randomized blindly into three parallel groups: Group BC that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+2 ml saline 0.9%; low-dose dexamethasone group (Group DB4) that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+4 mg dexamethasone; and high-dose dexamethasone group (Group DB8) that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+8 mg dexamethasone. Results Postoperatively, pain scores were significantly lower in Group BD4 and Group BD8 compared with Group BC at rest and on movement at 6, 8, 12, and 24 h. There was a significant difference with respect to the duration of analgesia ( P = 0.0001), 24 h consumption of paracetamol ( P = 0.0001), 24 h consumption of meperidine hydrochloride ( P = 0.001), the number of patients who needed meperidine hydrochloride rescue analgesic ( P = 0.008), time to ambulation ( P = 0.0001), and incidence of postoperative nausea and/or vomiting ( P = 0.03) among groups. Conclusion Adding dexamethasone (4 or 8 mg) to isobaric bupivacaine TAP block reduces postoperative pain, reduces analgesic requirement, and promotes early ambulation in bariatric patients undergoing laparoscopic vertical banded gastroplasty in comparison with isobaric bupivacaine TAP block alone.

Earliest signs and management of leakage after bariatric surgeries: Single institute experience

BackgroundThe aim of this study was to describe the clinical presentation and outcomes of treatment in patients who develop gastrointestinal leaks after different bariatric surgeries. MethodsRetrospective review of 632 consecutive bariatric surgical procedures performed from 1999–2009 in Alexandria University Hospital, Egypt. ResultsLeakage occurred in 10 patients. Symptoms and signs included tachycardia, fever, tachypnea, left shoulder pain, abdominal pain, chest pain, and/or change in the nature of the drain effluent. The earliest signs of presentation were tachycardia and unilateral decrease in air entry in all patients. The average time to diagnosis was 3.9±2.6days. In four patients contrast study was negative (40%). Six leaks occurred after laparoscopic sleeve gastrectomy (6.3%), 2 after laparoscopic gastric bypass (3.6%), one after open gastric bypass (2.3%), and 1 after laparoscopic vertical banded gastroplasty (2.4%). The most common leak location was at the esophagogastric junction (70%). Four patients (40%) required reoperations. A percutaneous abdominal drainage was placed in five patients (50%). In 2 patients (20%), the prophylactic drain was maintained in situ till cessation of leakage. Two patients (20%) died. Mean hospital length of stay was 13.9±7.8days. ConclusionsTachycardia and unequal breath sound in the early postoperative course are worrisome signs that warrant laparoscopic exploration even if contrast studies were negative. Patients with signs of sepsis or hemodynamic instability require emergent exploration. Leaks that are more insidious may be treated successfully with percutaneous drainage or maintenance of prophylactic drains.

Indications, safety, and feasibility of conversion of failed bariatric surgery to Roux-en-Y gastric bypass: a retrospective comparative study with primary laparoscopic Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RYGB) is considered the "gold standard" revision procedure. The purpose of this study was to compare the surgical outcome of primary laparoscopic RYGB (pLRYGB) to revisional open or laparoscopic Roux-en-Y gastric bypass surgery (rRYGB). A retrospective analysis of all patients who underwent pLRYGB or rRYGB from January 2003 to December 2009 has been performed. Demographics, indications for revision, and complications have been reviewed. The rRYGB and pLRYGB patients have been compared. Seventy-two patients underwent rRYGB, and 652 patients underwent pLRYGB. Mean follow-up was 35 and 45 months, respectively. Fifty-six rRYGB procedures were performed laparoscopically. The primary operations had consisted of laparoscopic gastric banding (n = 28), laparoscopic vertical banded gastroplasty (n = 19), laparoscopic sleeve gastrectomy (n = 6), laparoscopic RYGB (n = 3), and biliopancreatic diversion with duodenal switch (n = 16). Indications included weight regain (n = 29), malabsorption (n = 16), gastrogastric fistula (n = 5), band-associated problems (n = 3), and refractory stomal ulceration (n = 1). There was no significant difference in early or late postoperative complications when comparing rRYGB to pLRYGBP patients (11.1% vs. 5.52%, P = 0.069 and 19.4% vs. 24.2%, P = 0.465 respectively). Five rRYGB patients (7.04%) required reintervention (3 internal hernias, 1 ventral hernia, 1 laparoscopic exploration) compared with 101 pLRYGB patients (15.71%; P = 0.051). None of the patients died. Mean hospital stay was not significantly longer in the rRYGB group (5.38 vs. 4.95 days, P = 0.058). In our series, hospital stay, morbidity, and mortality of rRYGB were not significantly higher compared with pLRYGB. Furthermore, we believe that this type of revisional bariatric surgery should be performed in high-volume bariatric centers.

P-16 Realistic expectations following band to bypass revision

Background: Roux-en-Y gastric bypass (RYGB) is considered the gold standard revision procedure. The aim of this study was to compare our results of primary laparoscopic RYGB (pLRYGB) with revisional open or laparoscopic Roux-en-Y gastric bypass surgery (rRYGB). Methods: A retrospective analysis of patients who underwent pLRYGB or rRYGB from January 2003 to December 2009 was performed. Demographics, indications for revision and complications were reviewed. The rRYGB and pLRYGB patients were compared. Results: Seventy two patients underwent rRYGB and 652 patients underwent pLRYGB. Mean follow-up was 35 and 45 months respectively. Fifty six rRYGB procedures were performed laparoscopically. The primary operations had consisted of laparoscopic gastric banding (n 28), laparoscopic vertical banded gastroplasty (n 19), laparoscopic sleeve gastrectomy (n 6), laparoscopic RYGB (n 3) and biliopancreatic diversion with duodenal switch (n 16). Indications included weight regain (n 29), malabsorption (n 16), gastrogastric fistula (n 5), band-associated problems (n 3) and refractory stomal ulceration (n 1). There were no significant differences in early or late postoperative complications when comparing rRYGB with pLRYGB patients (11.1% vs. 5.52% p 0.069 and 19.4% vs. 24.2% p 0.465 respectively). Five rRYGB patients (7.04%) required reintervention (3 internal hernias, 1 ventral hernia, 1 laparoscopic exploration) compared to 101 pLRYGB patients (15.7%) (p 0.051). No patients died. Mean hospital stay was not significantly longer in the rRYGB group (5.38 vs. 4.95 days p 0.058). Conclusion: In our series hospital stay, morbidity and mortality of rRYGB were not significantly higher compared to pLRYGB. Furthermore, we believe that this type of revisional bariatric surgery should only be performed in high-volume bariatric centers.

Laparoscopic revision of vertical banded gastroplasty to Roux-en- Y gastric bypass: outcomes of 105 patients

Background Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term weight loss and band-related complications. The objective of the present study was to review the outcomes of patients who had undergone laparoscopic conversion of VBG to Roux-en- Y gastric bypass (RYGB) for weight loss or dysphagia and gastroesophageal reflux. Methods A retrospective review of prospectively collected data from all patients who had undergone revision of VBG to RYGB was performed. The data on the symptoms, weight loss, co-morbidities, and complications were collected. Results From July 1999 to April 2010, 2397 bariatric procedures were performed. Of these, 105 (4.4%) were laparoscopic revisions of previous VBG to RYGB. Of the 105 patients, 103 had undergone open VBG and 2 laparoscopic VBG. Of the 105 patients, 97 were women and 8 were men. The average patient age was 49 years (range 23–71). The median preoperative body mass index was 42 kg/m 2 (range 20–72). Short- and long-term complications occurred in 40 patients (38%). No patients died. The median length of stay was 2 days. At an average follow-up of 31 months (range 1–96), the median percentage of excess weight loss was 47% (range −24% to 138%). The median decrease in body mass index was 8 kg/m 2 (range −6 to 30). Dysphagia had improved or resolved in 100%. Gastroesophageal reflux disease had improved or resolved in 95%. Diabetes had improved or went into remission in 90%. Hypertension had improved or resolved in 62%. Obstructive sleep apnea had improved or resolved in 96%. Conclusion The results of our study have shown that laparoscopic revision of VBG to RYGB is a feasible procedure that can provide acceptable weight loss and reversal of weight-related co-morbidities. Complications were common after revisional bariatric surgery.

10-year Follow-up of Laparoscopic Vertical Banded Gastroplasty

To evaluate the long-term results of laparoscopic vertical banded gastroplasty (VBG) for morbid obesity. Laparoscopic VBG, a safe and straightforward bariatric procedure characterized by good short-term results, has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure. Nevertheless, some authors have recently reported long-term efficacy in selected patients. All patients who underwent laparoscopic VBG were included in a prospective database. Patients reaching 10-year follow-up received a complete evaluation including clinical, endoscopic, and biochemical examinations. Between January 1996 and March 1999, 266 morbidly obese patients underwent bariatric procedures. Among them, 213 were selected for laparoscopic VBG; exclusion criteria were as follows: contraindications to pneumoperitoneum, gastroesophageal reflux disease, and psychological contraindications to restrictive procedures. Mean age, preoperative weight, and body mass index were 36.9 years, 123.6 kg, and 45.4 kg/m, respectively. Intraoperative complication rate and conversion rate were 0.9% and 0.9%, respectively. Early postoperative complication rate was 4.2% and early reoperation rate was 0.5%. Mean hospital length of stay was 6.3 days. Mortality was nil. The 10-year follow-up rate was 70.4% (150 patients). Late postoperative complication rate was 14.7%, and 10-year revisional surgery rate was 10.0%. The excess weight loss percentages at 3, 5, and 10 years were 65.0%, 59.9%, and 59.8%, respectively. The resolution and/or improvement rate for comorbidity were 47.5% for hypertension, 55.6% for diabetes, 75% for sleep apnea, and 47.4% for arthritis. Mean Moorehead-Ardelt Quality of Life Questionnaire and BAROS values were 1.4 and 3.8, respectively. The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures. Given the low postoperative morbidity for laparoscopic VBG, its present clinical role should be, in our opinion, reevaluated.

Gastroesophageal reflux disease and esophageal motility in morbidly obese patients submitted to laparoscopic adjustable silicone gastric banding or laparoscopic vertical banded gastroplasty

Laparoscopic adjustable silicone gastric banding (LASGB) and laparoscopic vertical banded gastroplasty (LVBG) are the most frequently performed restrictive operations for morbid obesity. The question of whether bariatric restrictive procedures increase or reduce gastroesophageal reflux disease (GERD) remains open. This study aimed to compare the long-term results of LASGB with those of LVBG in terms of postoperative GERD and esophageal motility function. From February 1999 to December 2000, 175 patients underwent bariatric surgery. After 75 of these patients were excluded from the study, the remaining 100 patients were randomly assigned to one of two treatment groups: LASGB or LVBG. The end points of the study were evaluation of clinical and instrumental GERD and esophageal function. The follow-up protocol included clinical assessment using the Gastroesophageal Reflux Health-Related Quality-of-Life (GERD-HRQOL) scale at 3, 12, and 96 months. Esophageal manometry, 24-h pH monitoring, and endoscopy were performed at 12 and 96 months. At 12 months, GERD had developed in 13 (26%) LASGB and 11 (21.6%) LVBG patients. In the majority of cases, GERD resulted from pouch dilation or poor compliance and required either reoperation (ten after LASGB and three after LVBG) or endoscopic dilation of the neopylorus (four after LVBG). In all, 71 patients completed the 96-month follow-up protocol. The findings showed that three (11.5%) of 26 LASGB patients and four (9%) of 45 LVBG patients were receiving proton pump inhibitor (PPI) therapy for GERD. Postoperative lower esophageal sphincter (LES) pressure and esophageal motility did not differ from preoperative data except for the presence of aperistaltic waves in one LASGB and two LVBG symptomatic GERD patients. No significant association between gastric restrictive procedures and GERD or esophageal function was found during long-term follow-up assessment. The increased occurrence of GERD in the early follow-up period often is due to a technical defect or poor patient compliance.

Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial

Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity. A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years. Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05). Late complication rates were 36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05), 46.9% vs 43.1% at 5 years (NS), and 55.1% vs 47.1% at 7 years (NS). Late reoperation rates were 28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001), 38.8% and 2.0% at 5 years (p<0.001), and 46.9% and 7.8% at 7 years (p<0.001). Excess weight loss in LASGBs was 41.8% at 3 years, 33.2% at 5 years, and 29.9% at 7 years; excess weight loss in LVBGs was 60.9%, 57%, and 53.1%, respectively (p<0.05). This study demonstrates that in a carefully selected group of patients, LVBG is significantly more effective than LASGB in terms of late complications, late reoperations, and long-term results on weight loss.

A case of epigastric pain in the ED: late mechanical complication after vertical banded gastroplasty

A 50-year-old woman presented to our emergency department complaining of recurrent epigastric stabbing pain on eating of 1 month duration. She had a history of morbid obesity treated 13 years before with laparoscopic vertical banded gastroplasty (VBG). Diagnosis was made by radiology, after upper gastrointestinal series and abdominal unenhanced computed tomography. These demonstrated intragastric band migration, with outlet stenosis of narrowed stomach. Vertical banded gastroplasty is a miniinvasive approach that gives the benefits of shorter hospital stay, less postoperative pain, and quicker functional recovery. However, many complications are known and require recognition to be appropriately treated. In our case, the history and clinical presentation led to a high suspicion of intraabdominal pathology due to postoperative complication. Radiologic upper gastrointestinal investigation and computed tomography findings were then decisive to detect the intragastric band migration.

V-07: Intraoperative management of failed staple line during reversal of vertical banded gastroplasty for chronic obstruction

A common late complication of vertical banded gastroplasty (VBG) is outlet obstruction at the level of the band. One option for relieving the obstructive symptoms is to take down the VBG using an endolumenal stapling technique. We present a case of an intraoperative complication with a failed staple-line during laparoscopic VBG reversal. Intraoperative management of this complication includes distal gastrectomy with a Billroth II reconstruction.

Cost-Effective Restrictive Bariatric Surgery: Laparoscopic Vertical Banded Gastroplasty Versus Laparoscopic Adjustable Gastric Band

Among bariatric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the cost of two gastric restrictive procedures: laparoscopic vertical banded gastroplasty (LVBG) and laparoscopic adjustable gastric banding (LAGB). This is a prospective nonrandomized study comparing the cost effectiveness of LVBG and LAGB. Fifty-nine LVBG are compared to 83 LAGB performed during the same period, September 2005 and August 2006. Both groups demonstrate similar body mass index range and gender distribution. Cost analysis is evaluated as: preoperative, intraoperative, postoperative, follow-up, and management of complication cost. Both groups have similar preoperative and immediate postoperative cost. The material cost for LVBG is significantly lower than for LAGB ($1,326.42 for LVBG to $3,253.42 for LAGB). This material cost, however, excludes instruments and materials that are used in both procedures. Although both groups have similar postoperative routine visits, LAGB visits require band fills which increase its cost by $28 if fills are by palpation or $179 if by ultrasound. The complications in LAGB were also more severe with four patients returning to the operating room and another one medically managed for pulmonary embolism. These are at a higher cost compared to LVBG where none of the patients require reoperation or readmissions. The rate of percentage excess weight loss in LVBG patients however is more rapid than in LAGB patients. LVBG required less expensive instruments and materials for the operation and was associated with a higher rate of weight loss and less complications.

High revision rates after laparoscopic vertical banded gastroplasty

Background To evaluate, in a surgical department at a university hospital in Stockholm, Sweden, the long-term results after laparoscopic vertical banded gastroplasty (VBG), with special emphasis on revisional surgery. Few studies are available with long-term results after laparoscopic VBG. Some short-term studies have shown results similar to gastric banding. Methods All consecutive patients who underwent attempted laparoscopic VBG between 1995 and 2005 were followed up regarding weight loss and the need for revisional surgery. Follow-up was from the date of surgery to the end of the observational period (December 2006). Results In 486 patients, laparoscopic VBG was attempted. Of the 486 cases, 64 were converted to open surgery. Conversions were common in the first patients, with a conversion rate of 4% during the last 100 patients. The mean body mass index at surgery was 42.4 kg/m 2. The median follow-up was 3 years (range 0–11). All patients lost weight. A total of 104 patients (21%) required revisional surgery 114 times during the follow-up period, with food intolerance/vomiting and insufficient weight loss the most common reasons. Of the 104 patients, 31 underwent repeat VBG, of whom 10 needed a secondary revisional procedure, and 49 required conversion to gastric bypass, of whom none have required additional revisional surgery. Conclusion Laparoscopic VBG is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results. We have abandoned VBG as a surgical option in the treatment of obesity.

Disappointing results with a 5 cm calibrating device for laparoscopic vertical banded gastroplasty

The gastric outlet represents a critical point of laparoscopic vertical banded gastroplasty (LVBG): the diameter and the material used to calibrate the gastric outlet are essential for long-term success. We present the results of our initial clinical experience with the Proring band, a new calibrating device specifically designed to calibrate LVBG outlet. Between February and April 2004, 13 LVBG were performed using the Proring band. There were 12 women and one man; their mean age was 44 years; mean preoperative weight was 118.8 kg; mean body mass index (BMI) was 44.4 kg/m(2). The immediate postoperative course was uneventful in all cases. In the follow-up 10 patients out of 13 (76.9%) presented a sudden or progressive food intolerance. Five patients were immediately reoperated by laparoscopic approach and five underwent endoscopic dilatation with initial clinical improvement; early recurrence of symptoms despite further dilatations occurred in four out of five cases. These four patients were then reoperated. Therefore a total of nine (69.2%) patients underwent a laparoscopic reoperation with Proring band removal and its replacement with a polypropylene band. In seven cases an intraoperative endoscopic dilatation was associated with the laparoscopic procedure. Outcome was successful in all cases, with discharge after two days. The results of our experience using the Proring band are unsatisfactory, showing 76.9% with outlet stenosis and 69.2% with reoperations. These data compare negatively with our previous experience on more than 900 VBG procedures using polypropylene mesh.

Psychological Predictors of Outcome in Vertical Banded Gastroplasty: a 6 Months Prospective Pilot Study

At present, bariatric surgery is the most effective treatment for morbid obesity. Several factors appear to influence the patient's ability to adjust to the postoperative condition, but reliable predictors are lacking. The aim of this study was to assess whether psychological presurgical variables can predict outcome of vertical banded gastroplasty (VBG) in the short term. 38 severely obese patients (6 men and 32 women) underwent laparoscopic VBG. All were assessed prospectively at TO (before surgery) and at T6 (6 months after surgery) with a semi-structured interview and a battery of psychological tests: State Trait Anger Expression Inventory (STAXI), Eating Disorder Inventory (EDI-2), Symptom Checklist 90 (SCL-90), Beck Depression Inventory (BDI), Binge Eating Scale (BES), Body Shape Questionnaire (BSQ), and (only at TO) the Temperament and Character Inventory (TCI). The comparison between TO and T6 found a significant weight loss and an improvement in several dimensions of EDI-2, BDI, and BSQ, together with an increase in the frequency of vomiting. Self-directedness (TCI) and Body Dissatisfaction (EDI-2) appear to be predictors of short-term outcome regarding weight loss. Self-transcendence (TCI) is associated with emerging side-effects. Although larger and longer studies are necessary to confirm these data, Self directedness and Self trascendence emerge as predictors of 6 months clinical and psychological outcome of VBG.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: results of a 2-year follow-up study

The world's epidemic of obesity is responsible for the development of bariatric surgery in recent decades. The number of gastrointestinal surgeries performed annually for severe obesity (BMI > 40 kg/m2) in the United States has increased from about 16,000 in the early 1990s to about 103,000 in 2003. The surgical techniques can be classified as restrictive, malabsorptive, or mixed procedures. This article presents the results for 2 years of bariatric surgery in the authors' minimally invasive center and analyzes the results of the most used surgical techniques with regard to eating habits. Between January 2002 and January 2004, the authors attempted operations for morbid obesity in 110 consecutive patients adequately selected by a multidisciplinary obesity unit. This represented 43% of all consultations for morbidly obese patients. The patients were classified as sweet eaters or non-sweet eaters. All sweet eaters underwent gastric bypass. The procedures included 70 Roux-en-Y gastric bypasses, 39 Mason's vertical banded gastroplasties, and 1 combination of vertical gastroplasty with an antireflux procedure. Revision procedures were excluded. The mean age of the patients was 41.36 years (range, 23-67 years), and 72.3% were female. The mean preoperative body mass index was 44.78 kg/m2 (range, 34.75-70.16 kg/m2). The mean operating time was longer for gastric bypass than for the Mason procedure. Three patients required conversion to an open procedure (2.7%). The two operative techniques had the same efficacy in weight reduction. Early complications developed in 11 patients (10%), and late complications occurred in 9 patients (8.1%). The postoperative length of hospital stay averaged 4.4 days (range, 1-47 days; median, 4 days), and was longer in the gastric bypass group. The mortality rate was zero. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used. With zero mortality and low morbidity, bariatric surgery performed for adequately selected patients is the most effective therapeutic intervention for weight loss and subsequent amelioration or resolution of comorbidities. The patient's eating habits before surgery play an important role in the choice of the operative technique used.