Band Removal Research Articles

A505 Hiatal Hernia Repair and Conversion to Omega Loop Bypass after Gastric Band Removal

A505 Hiatal Hernia Repair and Conversion to Omega Loop Bypass after Gastric Band Removal

Technical Details and Result of a Minimally Invasive Management of Gastric Band Erosions: a Series of 47 Patients.

Laparoscopic adjustable gastric banding (LAGB) is proven to be a safe and effective treatment option for obesity in the long term. However, in recent decades, LAGB prevalence progressively decreased worldwide principally due to the incidence and the management of the complications. Understanding the optimal management of the complications becomes therefore of primary importance. The aim of this study is to describe a personal technical, laparoscopic solution of band erosion and to analyze outcomes in 47 patients. From October 1995 to January 2019, 3697 LAGB were performed at our institution. Since November 2011, an original laparoscopic gastric banding removal technique was introduced. All the bands placed in these patients were Lap-Band AP System (Allergan, Irvin, CA). The data of the patients who underwent gastric band removal because of band erosion were retrieved from a prospectively collected institutional database, and used for the present retrospective evaluation. Ninety-four patients (2.5% of the entire casuistic) with eroded band were diagnosed and treated at our institution. Forty-seven patients were treated with the laparoscopic gastric banding removal technique introduced in November 2011. All the operations have been performed laparoscopically with no conversion or intraoperative complications. There were neither major complications nor peri-operative (30days) mortality. Proper preoperative management and a standardized minimally invasive technique could help to cope with erosion, the most frightening complication of LAGB. Understanding the optimal management of complications and safe reoperation techniques can contribute to a rational use of the LAGB, reversing the current declining tendency.

Automated Algorithm for Accurate Doppler Profile Detection of MST Radar Signals Considering Removal of Interference

Identifying the accurate radar echo returns from the MST (Mesosphere-Stratosphere–Troposphere) region poses serious challenges, as the radar echo signals are of very low amplitude and hidden in noise. The process of extraction of the relevant signal information becomes intricate when the spectra sometimes are infected with interference signals of non-atmospheric origin. An automated algorithm is suggested for eliminating the interference bands in the Doppler spectra of MST radar signals. The process of removal of interference and de-noising of the radar echoes using soft thresholding techniques was achieved simultaneously. The algorithm was practically applied to interference contaminated MST radar data taken from National Atmospheric Research Laboratory (NARL), Gadanki, Tirupati and studied for removal of interference bands. It was found that the projected algorithm effectively removes multiple interference bands and also improves signal detectability. The power and Doppler values (moments) are estimated using FFT and HHT (Hilbert Huang Transform) and median Doppler is plotted on Doppler power spectrum and compared.

Outcomes of routine upper gastrointestinal series screening and surveillance after laparoscopic adjustable gastric banding.

Esophageal dilatation and dysmotility are known complications of the laparoscopic adjustable gastric band (LAGB), but their incidence varies widely in the literature. There are no formal recommendations guiding surveillance for these potentially underdiagnosed pathologies. This study demonstrates the utility and outcomes of a yearly upper gastrointestinal series screening protocol to detect and manage esophageal dysfunction after LAGB. We reviewed charts for all patients presenting for an outpatient surgical encounter related to LAGB between January 1, 2015 and December 31, 2017. Exclusion criteria included failure to undergo UGIS 6 months or more after band placement, or having undergone band placement in combination with another bariatric procedure. Descriptive statistics were used to characterize demographics, imaging findings and surgical outcomes. All imaging classifications were based on final radiologist report. Means were compared using a Student's t test. A total of 322 records were reviewed with 39 patients excluded; 31 without UGIS and 8 with concomitant gastric bypass. 85% were female with an average age of 50years. 66.8% identified as white or Caucasian with 24.7% black/African-American. Greater than 75% of the cohort had at least 5-year follow-up interval. UGIS was performed for symptoms in 66.1% and for routine screening in 33.9%. Of asymptomatic patients, 47.9% demonstrated esophageal dilatation or dysmotility on UGIS, similar to 51.3% of symptomatic patients. 96.8% of all patients went on to band removal. Sixty-four patients had repeat UGIS an average of 8months following band removal, of which 40.6% were persistently abnormal. The incidence of esophageal pathology was significantly higher than most reported series, as was the number of patients with persistently abnormal UGIS despite band removal. The data supports our policy of yearly UGIS for all post-LAGB patients, with strong recommendation for band removal if esophageal dilatation or dysmotility is found.

Surgical therapy of weight regain after Roux-en-Y gastric bypass

BackgroundRoux-en-Y gastric bypass (RYGB) is a well-established surgical method for morbid obesity; however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet. ObjectivesThe aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University in a larger number of patients, concerning further weight loss, complications, and reoperations. SettingUniversity hospital, Austria. MethodsThis study includes all patients with RYGB who were reoperated due to WR at the Vienna Medical University by December 2016 (n = 84). The follow-up rate was 93%. The following 4 approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing plus pouch banding, and (4) common limb shortening (i.e., distalization). ResultsThe mean maximum excess weight loss referring to the WR procedure in the 4 groups was as follows: group 1: 69.0% ± 35.2%, group 2: 62.8% ± 39.5%, group 3: 83.1% ± 30.9%, and group 4: 81.5% ± 41.6%. Reoperations occurred in the following different groups: group 1 had 2 balloon dilations (20%), groups 2 (n = 13) and 3 (n = 29) had 5 (38% and 17%) band removals each, and group 4 had 9 reversal procedures due to malnutrition (30%). ConclusionsThere are nonsignificant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further reoperations. While there was no risk of malnutrition with pouch resizing, there was with distalization. Pouch banding (with or without resizing) poses a higher risk of dysphagia.

Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer.

Background:The treatment of large osteochondral lesions of the talus (OLTs) is challenging due to the poor intrinsic reparative capability of the damaged articular cartilage. Autologous transfer of bone and periosteum has been used successfully in the treatment of large defects in animals, and therefore it was believed that this technique might show similar results in humans. The purpose of this study was to assess the outcome of an innovative technique for autologous transplantation of cancellous tibial graft with periosteal transfer in large OLTs.Methods:Forty-one patients (22 females, 19 males), with a mean age of 34.9 years (range, 18-72 years), with a large OLT (>200 mm2) were treated with autologous bone graft and periosteum transfer. OLTs averaging 310 mm2 were identified on a preoperative computed tomography scan. The procedure consisted of malleolar osteotomy, curettage of sclerotic bone, autologous bone graft from the proximal tibia, and transfixion of periosteum over the graft. Outcome measures, including the pain visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Disability Index (FADI), were compared between preoperative and 1 and 2 years following surgery.Results:There were significant improvements in VAS pain score from 7.7 before surgery to 1.1 at 1 year after surgery and 0.4 at 2 years or more after surgery. The AOFAS and FADI scores were also significantly improved from 40.3 and 53.3 preoperatively to 95 and 93.2 postoperatively at 1 year and 95 and 93.2 at 2 or more years postoperatively, respectively. Postoperative complications included 2 patients who required removal of medial malleolar osteotomy tension bands due to symptomatic hardware. There were no nonunions or malunions of the osteotomies and no donor site complications.Conclusion:Autologous bone graft and periosteum transfer was an effective treatment for large OLTs leading to significant decreases in pain and improvement in functional scores at more than 2 years after surgery.Level of Evidence:Level IV, retrospective case series.

Long-term results of the patients who were applied laparoscopic adjustable gastric banding.

The most effective treatment step in morbid obesity is surgical treatment. The purpose of the present study was to investigate the long-term follow-up results and success rates in laparoscopic adjustable gastric banding. The change in body mass index, percentage of excess weight loss, comorbidities, and resulting complications were investigated in 220 patients who were morbidly obese and applied laparoscopic adjustable gastric band between April 2006 and February 2012, throughout the 6-year follow-up period. Forty-six patients who did not show up for their routine follow-ups were excluded from the study. In the present study, band removal percentage was 35.63%. The percentage of excess weight loss in patients who were followed up without removal of the band was 46.03%. Complications were observed in 46.5% of the patients. The most frequently observed complication among the major complications was band intolerance, which is also the most common cause of band removal. Band removal was considered as a failure in laparoscopic adjustable gastric band operations, and patients were referred to other surgical methods. When improved patient compliance and careful and close patient follow-up are provided in the early stages of laparoscopic adjustable gastric band application, it may be possible to reach percentage of excess weight loss results that would be the nearest to those achieved by gastric bypass or sleeve gastrectomy methods. However, high complication rates and necessity to perform other bariatric surgical procedures in the majority of the patients in the long-term follow-up suggest that the laparoscopic adjustable gastric band operation is not the first choice in bariatric surgery.

Gênese de Cavernas da Serra Norte, Carajás, Pará com base em estudos petrográficos e geoquímicos de Formações Ferríferas Bandadas

Este trabalho objetiva entender os processos responsáveis pela formação das cavernas desenvolvidas em jaspilitos, no platô de N4, em Carajás, Pará. O estudo baseou-se em análises petrográficas e geoquímicas do jaspilito buscando caracterizar a evolução mineralógica, textural e geoquímica das quatro categorias em que foi classificado, considerando seus graus de alteração intempérica: 1) jaspilito fresco (JF); 2) jaspilito pouco alterado (JPA); 3) jaspilito muito alterado (JMA); 4) minério de ferro (MN). Na transição do JF para o MN ocorre intensa lixiviação de SiO2 (de 62,51 para 0,51%) e consequente enriquecimento no teor de Fe2O3t (de 56,48 para 97,71%). O chert e o jaspe são lixiviados, acarretando a formação de microcavidades de dissolução, até a retirada completa da banda de sílica (na ordem de 50 a 60% em volume). Por outro lado, há neoformação de duas variedades de hematita, a Hm-2 e a Hm-3, além de goethita. Verificou-se que a gênese das cavernas está inicialmente relacionada a processos químicos de dissolução e lixiviação da sílica, que foi ocasionada pela percolação de fluidos de origem meteórica, canalizados pelo do bandamento do jaspilito, aliado também à inclinação das camadas, que serviram de caminhos preferenciais para essas soluções. Processos de erosão subterrânea, colapso e abatimento do material residual aceleraram o aumento dos espaços vazios no jaspilito com a consequente formação das cavernas. Interpreta-se que os processos iniciais que atuaram na formação das cavernas são os mesmos que condicionaram a formação do minério friável da mina estudada.

Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography

The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5±3.4min, the average operation duration was 47±3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3±8.1mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2hr after operation; this patient was re-pressurized and re-timed. This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.

Is the Morbidity Increased for Gastric Band Removal When the Band Is Placed Around the Esophagus?

Introduction: Laparoscopic adjustable gastric band (LAGB) procedures declined worldwide in the recent years. In the majority of the national registers, the numbers of gastric band removal and revisions following LAGB have surpassed the implants. Still a good knowledge of different techniques is important for young bariatric surgeons to diminish the morbidity of revisional surgery. Methods: From January 2015 to December 2016, a total of 139 patients were retrospectively reviewed after undergoing a gastric band removal. The study included all consecutive patients who underwent a gastric band removal in this period of time with no exclusion criteria. Sixteen patients (18.8%) received the perigastric technique, 57 patients (67.1%) received the pars flaccid technique, 54 patients (38.8%) received bands with periesophageal technique, and for 12 patients (14.1%), the operative reports did not allow to identify the techniques used. In the present study, the operative times and the reported complications of the three main bands techniques were compared. Results: There were 124 women (89.2%) and 15 men (10.8%), with a median age of 44 years (range: 24-71). The overall mean preoperative body mass index was 34 ± 7.6 kg/m2 (range: 22-52 kg/m2), and the mean preoperative weight was 93.7 ± 24.9kg (range: 49-165 kg). One hundred and seventeen patients (84.2%) had procedures performed on an out-patient basis. The overall mean operative time was 23.9 ± 13.7 minutes (range: 7-83 minutes). We recorded three cases of bleeding with one conversion to laparotomy. The overall percentage of complications in the entire series was 6.5%. No mortality was recorded. Conclusions: Our study regarding the band removal revealed that no correlation was found for operative morbidity among the three different types of bands. The only proven difference was the operative time, which was greater for periesophageal approach. For the latter one, a particular attention should be paid to the risk of injury for diaphragmatic or left suprahepatic vein.

Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

Excessive opioid prescribing creates risk for abuse and adverse effects, but must be balanced against individualized pain control. Minimal literature exists to guide providers in the postoperative bariatric surgical setting. We compare opioid prescribing practice for minimally invasive bariatric surgery in a university hospital with self-reported patient use and satisfaction. This data is used to create practice guidelines for postoperative prescriptions. A 10-question survey was administered at the first postoperative office visit. All patients at this visit were eligible. None declined or excluded. We analyzed 115 patients for 3 procedures: laparoscopic sleeve gastrectomy (LSG; n = 53), laparoscopic roux-en-Y gastric bypass (LRYGB; n = 50), and laparoscopic adjustable gastric band removal (LAGBR; n = 12). Outcomes included number of pills prescribed (verified), proportion used, duration of use, satisfaction with pain control, and non-narcotic analgesic use. An average of 27 ± 10 pills were dispensed for LSG, average 4.1days of use; 28 ± 7 pills for LRYGB, 4.6days; and16 ± 9 pills for LAGBR, 2.6days. Fifty to 74% retained more than half or all of their opioids at 2weeks. Fifty-four percent utilized non-narcotic analgesics. Overall, 91.3% reported adequate pain control. For each procedure, average number of pills used was calculated with representative values for "less than half left" (75% of average number of pills prescribed) and "more than half left" (25% of average number of pills prescribed). For LSG, an average of 9 pills were used; LRYGB 14 pills, and LAGBR 7 pills. Opioids are overprescribed following most common surgical procedures, but only one study has evaluated patterns after bariatric surgery. Our survey-based tool examines prescribing, utilization and satisfaction following common minimally invasive bariatric procedures. Opioid prescriptions were variable, and excessive for most patients. We now recommend prescribing no more than 15 pills after these operations.

Public cost of privately inserted laparoscopic adjustable gastric bands.

BackgroundLaparoscopic adjustable gastric banding (LAGB) remains a commonly performed procedure for morbid obesity. Concerns regarding its long‐term consequences include high rates of band removal from complications and failure to lose weight. Many private practices continue to perform LAGB but, owing to short follow‐up periods, the burden of surgical complications falls upon National Health Service (NHS) bariatric units. This study aimed to review the NHS treatment of patients for complications related to privately performed LAGB.MethodsAll surgical complications following bariatric surgery referred to the Welsh Institute of Metabolic and Obesity Surgery (WIMOS) between September 2010 and September 2014 were reviewed. Type of complication, procedures performed, and number of outpatient attendances and inpatient stays were recorded. Costs of treatment were estimated using standard tariffs.ResultsA total of 78 patients presented with complications after privately performed bariatric surgery. Sixty had undergone LAGB; the remainder had had other bariatric procedures. Median age was 45 (range 22–78) years, and 65 (83 per cent) were women. Urgent band deflation was undertaken in 53 patients. Band removal surgery was required in 32 patients; one patient needed a subtotal gastrectomy. There was a total of 123 outpatient/ward attendances and 340 days of inpatient care, including 10 days of intensive care. The estimated total cost to the NHS of managing these patients was €337 400 (€84 350 per annum).ConclusionThe cost burden to the NHS of managing the complications of bariatric surgery performed in the private sector is considerable. Although it is imperative that such complications be managed in well equipped specialist units, private surgery providers should have better follow‐up plans and/or contractual agreements with the NHS.

Randomized Comparison of Terumo® Coated Slender™ versus Terumo® Noncoated Traditional Sheath during Radial Angiography or Percutaneous Coronary Intervention.

Background The transradial approach is generally associated with few complications. However, periprocedural pain is still a common issue, potentially related to sheath insertion and/or arterial spasm, and may result in conversion to femoral access. Radial artery occlusion (RAO) following the procedure is also a potential risk. We evaluate whether the design of the sheath has any impact on these variables. Methods A total of 1,000 patients scheduled for radial CAG or PCI were randomized (1:1) to the use of a Slender or a Standard sheath during the procedure. Randomization was stratified according to chosen sheath size (5, 6, 7 French) and gender. A radial band was used to obtain hemostasis after the procedure, employing a rapid deflation technique. A reverse Barbeau test was performed to evaluate radial artery patency after removal of the radial band, and level of pain was assessed using a numeric rating scale (NRS). Results Use of the Slender sheath was associated with less pain during sheath insertion (median NRS 1 versus 2, p=0.02), whereas no difference was observed in pain during the procedure, radial procedural success rates, use of analgesics and sedatives during the procedure, and radial artery patency following the procedure. Rate of RAO was 1.5% with no difference between groups. Conclusion The use of the hydrophilic coated Slender sheath during radial CAG or PCI was associated with less pain during sheath insertion, whereas no difference in other endpoints was observed. A rapid deflation technique was associated with RAO of only 1.5%.

Incidence and predictors of forearm hematoma during the transradial approach for percutaneous coronary interventions

BackgroundThe transradial approach for percutaneous coronary intervention (TRA-PCI) reduces vascular complications compared with the transfemoral approach (TFA). Although hematoma formation is less frequent with the TRA than TFA, it is not uncommon, and its presentation ranges from mild hematoma to compartment syndrome. Incidence and predictors of hematoma have not been well studied. Methods and resultsThe present study was conducted to prospectively evaluate the incidence and predictors of forearm hematoma after TRA-PCI. The study population consisted of consecutive patients undergoing TRA-PCI. Baseline and procedural characteristics and clinical outcomes were prospectively collected. All patients were observed for forearm/arm hematoma immediately after procedure, after band removal, before discharge, and whenever the patient complained of pain/swelling in the limb. Logistic regression analysis was performed to determine the predictors for hematoma formation. A total of 520 patients who had successfully completed TRA-PCI were included in the final analysis. The mean age was 55.2 ± 9.5 years, and 24% patients were women. Hematoma occurred in 53 (10.2%) patients. Hematomas were of grade I, II, III, and IV in 22 (4.2%), 9 (1.7%), 18 (3.5%), and 4 (0.8%) patients, respectively. On multivariate logistic regression analysis, age, body mass index, multiple puncture attempt, glycoprotein IIb/IIIa receptor blocker use, nonclopidogrel agent use for dual antiplatelet therapy, and multiple catheter exchanges emerged as independent predictors for hematoma formation. ConclusionsForearm hematoma following TRA-PCI occurs in about 10% patients. Most hematomas occur near the puncture area. The independent predictors for hematoma formation are age, body mass index, multiple puncture attempts, intensive antiplatelet therapy, and multiple catheter exchanges.

03:36 PM Abstract No. 67 Expedited TR Band removal after transradial visceral interventions: a single-center experience

The current hemostasis protocol provided by Terumo radial (TR) band (Terumo, Sommerset, NJ) manufacturer and cited by current interventional radiology literature for visceral interventions is non occlusive patent hemostasis achieved by inflation of TR band for 60-90 minutes, with subsequent slow deflation until eventual removal. We aimed to determine if the average time to TR Band removal can be reduced without adverse effects. Transradial non-coronary visceral interventions performed between July 2017 and August 2018 were retrospectively reviewed. Following TR band application, the nursing staff was instructed to start TR band deflation process at 30-60 minutes. If bleeding was noted, 1 cc of air was reinflated and deflation was resumed in 30 minutes. Data collected included demographics, procedure details, nursing notes for TR band removal, and complications. 37 patients (26 Men, 17 Female, Mean age 46.4 years) underwent 47 transradial interventions with post operative TR band placement. Procedures included 11 Uterine Fibroid Embolization, 19 Y90 MAA and treatment, 12 chemoembolization and 5 other. All patients received an intra-arterial cocktail of 2.5 mg verapamil, 3000 units heparin and 200 mcg of nitroglycerin. All procedures were performed with a 5F glide slender sheath(Terumo, Sommerset, NJ). Median procedure time was 56.64 minutes (range 30- 100 mins). 43/47 ( 91.5%) patients had no access site bleeding after initial band deflation (mean time of removal: 53.1 mins, standard deviation: 14.3 mins). 4/47 (8.5%) patients had bleeding during initial band deflation, and were re-inflated as per protocol aforementioned. Mean time to successful removal in these patients was 77.5 minutes (±25.3 minutes). There were no access site bleeding complications in the immediate postoperative period or clinic follow up. 1 patient had asymptomatic radial artery thrombosis at 2 week follow up. Expedited removal of TR band at 30-60 minutes may be safe for non occlusive hemostasis following transradial visceral interventions. Future prospective studies with larger patient cohorts would be helpful.

Effect of B2 morphology on the mechanical properties of B2-strengthened lightweight steels

Tensile properties and formability of B2-strengthened Fe-15Mn-10Al-0.8C-5Ni and Fe-16Mn-8Al-1C-5Ni lightweight steels have been investigated. Our results show that tensile properties along rolling and transverse directions as well as formability are strongly affected by the morphology of B2. The removal of B2 bands and a development of more homogeneous microstructure containing fine B2 particles in Fe-16Mn-8Al-1C-5Ni steel results in isotropic tensile properties and significant improvement of formability compared to B2 bands containing Fe-15Mn-10Al-0.8C-5Ni steel. Moreover, such improvements are achieved without any degradation of tensile properties, despite a much lower fraction of B2 particles in the former than the latter.

Outcomes After Laparoscopic Conversion of Failed Adjustable Gastric Banding (LAGB) to Laparoscopic Sleeve Gastrectomy (LSG) or Single Anastomosis Duodenal Switch (SADS).

Inadequate weight loss following LAGB (laparoscopic adjusted gastric banding) requiring band removal and conversion to another bariatric procedure is common. There is a paucity of objective data to guide procedure selection. Single anastomosis modifications (SIPS, SADI, SADS) of the duodenal switch biliopancreatic division (DS-BPD) are being investigated. Laparoscopic sleeve gastrectomy (LSG) has become the most prevalent primary bariatric procedure and has been used for revision following LAGB. The purpose is to investigate single-stage LAGB removal to LSG SADS (single anastomosis duodenal switch). A matched cohort analysis compared each revision to a similar patient having a primary procedure. This was performed to understand the impact of prior banding on outcomes with each procedure. This is a retrospective study to investigate the outcomes of revision of LAGB for inadequate weight loss to LSG or SADS. To determine whether prior banding impairs results, a matched cohort was done comparing each revision to a patient that had a primary procedure. As expected, patients who had SADS had greater weight loss than LSG. There was no difference in peri-operative and early complications. Both procedures resulted in weight loss. Importantly, with matched cohort, prior LAGB decreased weight loss outcomes in LSG, but not SADS. Conversion of LAGB to LSG or SADS results in weight loss. The presence of LAGB decreases weight loss in LSG, but not in SADS. This can have important implications for long-term outcomes.

Rate of Complications at Early Removal of Compression Bandage After Transradial Coronary Angiography

to compare rates of access site complications at early (after 4 hours) and traditional (after 24 hours) removal of a compression bandage after diagnostic transradial (TR) coronary angiography (CA) in patients not receiving anticoagulants. We included into this study 392 patients (mean age 63±8.7 years, 62.8% men) who underwent transradial coronary angiography. Patients were divided into 2 groups. In group 1 patients (n=221) compression bandage was removed from puncture site in 4 hours after procedure with subsequent control of radial artery patency using presence of pulse metric curve during ulnar artery compression (the reverse Barbeau test with pulse oximeter). In patients of group 2 (n=171) compression band was removed after 24 hours. In both groups control of radial artery patency was carried out after 24 hours using the reverse Barbeau test. Upon detection of radial artery occlusion (RAO) ultrasound imaging of the forearm arteries was performed. No RAO was detected in group 1 while in group 2 number of detected RAO was 15 (8.8%) (р<0.05). Rates of hematomas at puncture site were not significantly different. Puncture site bleeding after band removal requiring repeated banding occurred in 1 patient of group one (0.6%); no such cases were registered in group 2 (p>0.05). Compared with traditional method early removal of compression bandage after TR CA was associated with lower rate of RAO.

A 5-Year History of Laparoscopic Gastric Band Removals: an Analysis of Complications and Associated Comorbidities.

This study was undertaken to examine the factors contributing to laparoscopic adjustable gastric band (LAGB) removals among adults > 18years of age. We hypothesized that female patients with multiple comorbidities would have increased removals. This retrospective exploratory study uses internal records and standard statistical methods of analysis. Eighty-five bands were removed (11.8% males, 88.2% females). The average BMI was 40.7 (n = 83). 2.4% of patients had removals between 0 and 12months, 18.8% between 39 and 51months, and 35.3% between 39 and 64months. 8.2% of treatment times were unknown. The average treatment time was 67.9months. 48.2% of patients had ≥ 2 comorbidities, GERD (44.2%) being the most frequent. 49.4% of patients reported dysphagia as the reason for band removal. 22.4% of removals were associated with band failures, none with port complications. The reason for band removal was unknown in 21.2% of patients. 67.1%, 32.9%, and 23.5% attended 30-, 60-, and 90-day follow-up appointments, respectively. Weight post-band removal surgery at 30, 60, and 90days was noted to be - 0.4%., 0.9%, and 0.4%, respectively. This study supports current literature suggesting LAGB may not be an effective long-term surgical intervention for obesity. Patients with > 2 comorbidities had increased rates of removal. Dysphagia was noted to be the primary reason cited for LAGB removal. Postoperative follow-up was found to be a significant challenge for LAGB removal patients. Further study is warranted to explore if these poor follow-up rates should be considered when risk stratifying LAGB patients for revisional surgery.

One Stage Laparoscopic Band Removal and Sleeve Gastrectomy after Failure of Gastric Banding in Morbidly Obese Patients

Background: Obesity is one of the public health problems nowadays which is associated with a variety of diseases including the whole systems, specially the cardiovascular system. Bariatric surgeries believed to be the most effective long-term management for morbid obesity that decrease both morbidity and mortality. One of these surgeries is laparoscopic adjustable gastric banding. Objective: To study the safety and effectiveness of single stage revision of failed gastric banding to sleeve gastrectomy only in uncomplicated cases who had failure of weight loss or regain weight after a period from having gastric banding. Patients and methods: The present study is a retrograde observational study including 150 morbidly obese patients who previously had laparoscopic adjustable gastric banding and failed to lose adequate weight or regained weight. Patients were recruited and treated at Ain Shams university hospitals from December 2015 to December 2017. All patients had laparoscopic band removal and sleeve gastrectomy in the same procedure. All patients received information about surgical technique, risks of the operation and other options for treatment. Results: The mean age of the cohort was 36± 10 years (range 20-60). Before band insertion the mean BMI of the cohort was 43.4 ± 5.2 (range 31.6-55.8). The mean interval between primary and revision surgery was 5.5±1 year (range 2.8-9.6). The mean BMI of the study prior to revisional laparoscopic band removal and sleeve gastrectomy was 42 ± 5.5 (range 35-50). The excess body weight loss percentage (EBWL%) in the first 3 months was 32% and 65% after 6 months. Conclusion: Laparoscopic gastric band removal with conversion to sleeve gastrectomy in one operation is applicable for patients with failure of weight loss or regaining weight after adjustable gastric band. It can be done with low incidence of complications, and yet a weight loss results that is similar to primary sleeve gastrectomy.