Swedish Adjustable Gastric Banding Research Articles

Swedish adjustable gastric banding – an underestimated risk factor for the development of esophageal cancer?

BACKGROUND: Patients with obesity are at higher risk for gastroesophageal reflux disease and also for adenocarcinoma of the distal esophagus. METHODS: Case report. RESULTS: We report on a 58-year-old male patient who developed adenocarcinoma of the distal esophagus (Barrett's cancer) 13 years after implantation of a SAGB (Swedish adjustable gastric banding). Predisposition to reflux combined with bad compliance (frequent overeating) lead to dilation of the pouch followed by impairment of the lower esophageal sphincter with a permanent exposition of the distal esophagus to refluxate. This "stasis esophagitis" over years finally ended in development of neoplasia. Consequently, the patient underwent an esophageal resection with gastric tube pull-up and intrathoracic anastomosis. CONCLUSIONS: From a functional point of view, preoperative work up before SAGB should include detailed history, endoscopy with biopsies of the z-line and esophageal manometry. In case of defective esophageal peristalsis or suspected incompliance of the patient, an implantation of a SAGB should not be performed.

Results and Complications after Swedish Adjustable Gastric Banding—10 Years Experience

Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach and adjustable to the patient's needs. Few long-term studies on Swedish adjustable gastric banding (SAGB) have been published. We here report our 10-year experience with 785 SAGB procedures. Between January 1996 and January 2006, 785 consecutive patients (81% women, 19% men) underwent laparoscopic SAGB. All data (demographic and morphologic, operative, and annual follow-up data) were prospectively collected in a computerized data bank. The postoperative follow-up program was performed largely by residents while 30 different surgeons performed the operation. Follow up data were available for 733 patients (98.3%); 52 patients (6.6%) were lost to follow-up. The median follow-up was 3.0 years (range, 1-10 years). The median total weight loss was 26 kg after 1 year and 40.5 kg after 8 years with a median EWL of 65.5% after 8 years. The median BMI decreased from 42.9 to 28.3 kg/m2. A total number of 688 complications occurred in 396 patients (50.4%). The most common complications were esophagitis (28.8%), pouch dilation (15.3%), esophageal dilation (12.5%), port problems (11%), band migration (6.5%), and band leakage (6.4%). Overall, 251 reoperations (32%) were performed. There was no mortality. From our 10-year experience, we can state that SAGB is an effective bariatric procedure for achieving weight loss. Because of the high complication and reoperation rate, it is necessary to select patients according to specific criteria for gastric banding.

High Complication Rate after Swedish Adjustable Gastric Banding in Younger Patients ≤25 Years

Swedish adjustable gastric banding (SAGB) is an effective treatment for morbid obesity. The main advantage of this procedure is that this operation is minimally invasive to the stomach and totally reversible and adjustable to the patient's needs. The aim of this observational study is to present our experience with patients < or =25 years old. Between January 1996 and January 2006, 107 patients (85 women, 22 men) of 785 consecutive patients who underwent SAGB during the study period were aged < or =25 years (13.6%). All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized data bank. The postoperative follow-up program was performed most of the time by residents, and 17 different surgeons performed the operation. The mean total weight loss was 27 kg after 1 year, reaching a total of 40 kg after 8 years. The mean EWL was 65.5% after 8 years, and the BMI decreased from 43.3 to 28.2 kg/m(2). In the 107 patients, there were 50 patients with 72 complications (46.7%) and 57 patients with no complication (53.3%). The most common complications were esophagitis (25.2%), pouch dilation (16.8%), port problems (6.5%), esophageal dilation (5.6%) and band leakage (4.7%). Overall, 31 patients (29%) needed a reoperation. There was no mortality. SAGB operation and the follow-up should only be performed by a small team of bariatric surgeons. Because of the high complication and reoperation rate, a gastric-band-specific patient selection will be necessary. On the basis of 8 years follow-up, SAGB is an effective bariatric procedure for achieving weight loss.

Results and Complications After Swedish Adjustable Gastric Banding in Older Patients

Swedish adjustable gastric banding (SAGB) is an effective treatment for morbid obesity. The aim of this study was to assess the efficacy and safety of SAGB in older patients aged >or=50 years. Between January 1996 and January 2006, 134 patients (102 women, 32 men) of 785 consecutive patients who underwent SAGB during the study period were aged >or=50 years. Two groups of patients were analyzed: Group 50 (n=107) patients aged 50-59 years and Group 60 (n=27) patients aged 60-69 years. All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized databank. One hundred thirty-four patients (17.1%) out of 785 entered the study. Mean percentage of excess weight loss (%EWL) was 37.5 at 1 year and 48.8 at 7 years, body mass index (BMI) fell from 43.3 to 33.1 at 7 years. In the 134 patients, there were 65 patients with 121 complications (48.5%) and 69 patients with no complication (51.5%). The most common complications were esophagitis (27%), esophageal dilation (16%), port problems (11%), pouch dilation (11%), band leakage (9%), and band migration (7%). Overall, 46 patients (34%) needed a reoperation. In Group 50, mean %EWL was 38.4 at 1 year and 54.9 at 7 years. BMI fell from 42.9 to 33.1 at 7 years. In the 107 patients, there were 55 patients with 99 complications (51%) and a reoperation rate of 35.5%. In Group 60, mean %EWL was 32.8 at 1 year and 41.2 at 7 years. BMI fell from 44.3 to 34 at 7 years. In the 27 patients, there were ten patients with 22 complications (37%) and a reoperation rate of 29.6%. There was no mortality. At 7-year follow-up, for older patients, SAGB is an effective bariatric procedure for achieving weight loss. Nevertheless, based on the high complication and reoperation rate, a gastric band-specific patient selection will be necessary.

Assessment of the Relationship Between Post-meal Satiety, Gastric Volume and Gastric Emptying After Swedish Adjustable Gastric Banding. A Pilot Study Using Magnetic Resonance Imaging to Assess Postsurgery Gastric Function

Swedish adjustable gastric banding (SAGB) is a common weight loss procedure performed worldwide. The exact mechanism by which it achieves appetite suppression, and hence weight loss, is not clear. One possible mechanism is altered meal handling by the post-SAGB stomach. Five post SAGB patients and five age/sex-matched controls were recruited. Pre- and post-meal magnetic resonance imaging (MRI) was performed with two liquid test meals of differing viscosity-locust bean gum (3.0%) and water. Appetite was assessed using ten-point visual analogue scales. There were significant relationships between hunger scores and esophageal, pouch and residual stomach fluid volume changes for the locust bean gum meal (p=0.033, 0.043 and 0.011, respectively). The rate constants for gastric emptying were similar in the two groups for both the gum (0.038+/-0.016 min(-1) for SAGB, 0.041+/-0.032 min(-1) for controls, p=0.44) and water meals (0.068+/-0.044 min(-1) for SAGB, 0.044+/-0.009 min(-1) for controls, p=0.35). An unexpected finding was asymptomatic esophageal meal retention with the locust bean gum meal in the post-SAGB arm (mean 16.9 ml at 15 min). There is no evidence of differences in volume-dependent gastric emptying between the normal and post-SAGB stomach. Further investigation of the phenomenon of esophageal retention, and its role in post-SAGB satiety, is warranted.

M1554 Long-Term Outcome After Distal Gastric Bypass Combined with Swedish Adjustable Gastric Banding (SAGB)

M1554 Long-Term Outcome After Distal Gastric Bypass Combined with Swedish Adjustable Gastric Banding (SAGB)

Prospective Evaluation and 7-Year Follow-up of Swedish Adjustable Gastric Banding in Adults with Extreme Obesity

BackgroundSwedish adjustable gastric banding (SAGB) is a widespread laparoscopic procedure in bariatric surgery. Few long-term data is available. AimTo determine long-term outcome after SAGB in 196 patients studied prospectively. Patients and Methods196 patients, 40 men, and 156 women have been operated from 1996 to 2005. Age was 38 ± 1 (mean ± sem) years. Mean follow-up was 63 ± 2 months. ResultsHospital morbidity was 3% (0.5% early reoperation); mortality was 0. Late complications were band migration (1%), leakage (5%), slipping (4%), or pouch dilatation (8%). Minor reoperations (tube replacement, port-related, and hernias) were needed in 7.5%. Cumulative major reoperation rate reached 32%. Eighteen percent had a band replacement; 14% had removal of band anatomy. Late mortality was 0.5%. Exactly 7 years after SAGB, BMI decreased from 45 ± 1 kg/m2 to 33 ± 1 kg/m2, and excess weight loss (EWL) was 61 ± 4%. Sixty-eight percent of the patients reached ≥50% EWL. ConclusionIn 14% of the patients, the band anatomy had to be removed. Seven years of intact band anatomy leads to a successful EWL of 61 ± 4% and to EWL of ≥50% in 68%. However, cumulative major reoperation rate of 32% in 7 years makes it mandatory to offer and discuss other bariatric procedures to the respective patients.

Port-Stapling zur Erleichterung der Portimplantation bei der laparoskopischen Magenbandoperation

The purpose of this study was to evaluate the applicability of a port stapling device to simplify and improve port implantation in laparoscopic adjustable gastric banding (LAGB). From November 2005 to September 2006, a prospective study was conducted on 23 consecutive patients who underwent LAGB with Swedish adjustable gastric banding. Patients were randomized to either conventional titanium-port implantation or port stapling using the "Velocity" device. No differences in age, body weight, body mass index, fascia depth or incision length were reported between the groups. Port implantation time was significantly less using port stapling (90+/-24 s) compared to conventional port implantation (521+/-138 s). Port related complaints postoperatively and at follow-up were equal in both groups. Port stapling is an excellent tool to facilitate port implantation, particularly in massively obese patients with a thick abdominal wall.

Outcome and Complications after Laparoscopic Swedish Adjustable Gastric Banding: 5-Year Results of a Prospective Clinical Trial

Bariatric surgery is currently the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and decreasing weight-related co-morbidities. A study was conducted to assess the effects, complications and outcome after laparoscopic Swedish adjustable gastric banding (SAGB) to 5 years. Between June 1998 and December 2005, all patients with implantation of a SAGB were enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications and re-operation rate. SAGB was performed in 128 patients (87 female, 41 male). Mean age was 40.2 +/- 5.3 years, with mean preoperative BMI 44.5 +/- 3.9 kg/m2. Overall mortality was 0%. Patient follow-up was 94.5%. BMI after 1, 2 and 5 years was 35.7 +/- 3.7 kg/m2 (P < 0.005), 33.7 +/- 3.8 kg/m2 (P < 0.001) and 31.8 +/- 3.8 kg/m2 (P < 0.001), respectively. Mean EWL after 1, 2 and 5 years was 33.3 +/- 6.8% (P < 0.005), 45.5 +/- 6.4% (P < 0.001) and 57.4 +/- 6.5% (P < 0.001), respectively. The nonresponder rate (EWL < 30%) after 2 and 5 years was 17.0% and 6.8%, respectively. The early complication rate (< 30 d) was 6.25% (8/128), with 5 minor and 3 major complications. Late complications (> 30 d) occurred in 10.9% (14/128), of whom 2 were minor and 12 were major complications. The overall re-operation rate was 11.7% (15/128). At 5-year follow-up, laparoscopic SAGB is a safe and effective surgical treatment for morbid obesity. Our results appear to confirm that SAGB is a safer surgical treatment regarding rate and severity of complications compared with gastric bypass and malabsorptive procedures.

Psychosocial Predictors of Weight Loss after Bariatric Surgery

The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery. After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB). Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m(2). Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m(2)), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m(2)). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047). The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.

Traitement de l’obésité morbide par anneau gastrique ajustable : un suivi clinique et radiologique

Purpose To evaluate the role of imaging for follow-up after treatment of morbid obesity by laparoscopic adjustable gastric banding (LAGB). Patients and methods Since 1996, more than 1,000 patients underwent gastric banding using 5 different types of devices. Our experience is based on a retrospective study (from September 1996 to September 2002) concerning 663 consecutive patients who underwent LAGB: 114 Lapband system (LB) and 549 Swedish adjustable gastric banding (SAGB). Upper gastrointestinal series were performed within 24-48 hours after surgery in all patients. Radiological examination was also used to detect complications and to adjust gastric band. Results The five types of gastric band are easily identified on plain films. Early and late complications are illustrated: pouch dilatation, slippage, band migration, rotation of the port, and system disconnection. Radiological criteria for adjustment of gastric band are explained on the basis of barium studies performed before and after any modification of the stoma size. Conclusion In patients treated with LAGB for morbid obesity, radiology plays an important role in evaluating early and late complications.

Effectiveness and cost-effectiveness of Swedish adjustable gastric banding versus conservative therapy in treatment of severe obesity

Effectiveness and cost-effectiveness of Swedish adjustable gastric banding versus conservative therapy in treatment of severe obesity

Is Laparoscopic Adjustable Gastric Banding a Day Surgery Procedure?

Laparoscopic adjustable gastric banding is the least invasive bariatric operation. However, just isolated attempts to perform this procedure as a Day Case have been published. This study highlights some aspects that might contribute to safe patient discharge within 23 hours after LAGB. Prospective evaluation of 20 consecutive patients was carried out. Patients were indicated for laparoscopic Swedish adjustable gastric banding (SAGB, Obtech, Ethicon Endo-Surgery) in a private Bariatric center in the first 6 months of 2003. The effect of extensive pre- and immediate postoperative education and psychological support, and information on postoperative health consequences delivered through a multi-disciplinary bariatric team effort, was evaluated, regarding the influence of these facilitators in shortening the length of hospital stay. Mean preoperative BMI of the 20 patients entering the study was 42.3. Mean operating-time was 91 minutes (58-112 min). Time spent on information and education of each patient was 60 minutes in total during the preoperative period. Average postoperative hospitalization was 21 hours. There were no intraoperative or early postoperative complications. Excess weight loss was 44% at 12 months after surgery. SAGB performed on a Day Case basis in selected patients who are subjected to intensive pre- and immediate postoperative dedicated education appears to be a feasible alternative.

Effects of weight loss on PLTP activity and HDL particle size.

Dyslipidaemia in obesity is characterized by hypertriglyceridaemia, low HDL-C levels, small, dense HDL particles and increased phospholipid transfer protein (PLTP) activity. In the present study, we investigated PLTP activity and HDL particle size in 16 morbidly obese, middle-aged women, who underwent Swedish Adjustable Gastric Banding surgery. Study subjects were tested within 2 months before and 1 y after surgery. PLTP activity was determined by exogenous substrate assay and HDL particle size by gradient gel electrophoresis, respectively. Pronounced weight loss after gastric banding surgery resulted in a significant decrease of PLTP activity from 8.42+/-2.04 to 7.43+/-2.21 micromol/ml/h (P=0.02). The size of HDL(2) particles increased signficantly from 14.04+/-0.86 to 14.28+/-0.64 nm (P=0.02) after body weight reduction, while no change in HDL(3) particle size was apparent. Our results suggest that dyslipidaemia in obesity is--at least partially--reversible by weight loss. We hypothesize that reduction of PLTP activity and increase of HDL particle size are important component factors in converting the atherogenic lipoprotein profile of obese subjects into a less atherogenic profile with weight loss.

Laparoscopic Swedish adjustable gastric banding: a five-year prospective study.

Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. However, the long-term complication rate and weight loss are still unclear. 824 patients underwent a laparoscopic Swedish Adjustable Gastric Banding (SAGB) in a 5-year period. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained for analysis. Mean age of the 824 patients was 43 +/- 1 years, with mean preoperative BMI 43 +/- 1 kg/m(2). No intra- or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 5.2%. Peri-operative complication rate was 1.2%. 97% of the patients were available for follow-up (maximum 5 years). Long-term complications occurred in 191 patients (23.2%). 135 complications (16.4%) were related to the band, and 56 (6.8%) to the access-port or to the tube. Mean excess weight loss was 30, 41, 49, 55 and 57 % after 1, 2, 3, 4 and 5 years respectively. 82.9% of the patients obtained >50% EWL after initial treatment. The results of this study suggest that laparoscopic SAGB can achieve an effective weight loss, with an acceptable mortality and morbidity rate.

Psychosocial consequences of weight loss following gastric banding for morbid obesity.

This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. After a minimum follow-up of > 8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partner's opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Weight Loss after Swedish Adjustable Gastric Banding: Relationships to Insulin Resistance and Metabolic Syndrome

The metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension, dyslipidemia, disturbance in glucose metabolism) associated with insulin-resistance. The cluster of risk factors defining the metabolic syndrome increases cardiovascular risk more than each single component. The aim of the present longitudinal study was to evaluate the relationship between weight loss and changes in insulin-resistance and in the prevalence of the metabolic syndrome 1-year after SAGB implantation. 51 premenopausal severely obese women (mean age 35.2 +/- 8.8 years, BMI 43.3 +/- 6.9) were enrolled. As a control group, 51 premenopausal non-obese women (BMI < 30) were enrolled. All obese subjects underwent successful implantation of the SAGB via videolaparoscopy. In all subjects insulin-resistance was estimated by HOMA index and metabolic syndrome was defined according to the criteria of the European Group for the Study of Insulin Resistance. HOMA (4.2 +/- 2.0 vs 1.9 +/- 0.8, P < 0.001) and the prevalence of the metabolic syndrome (58.8% vs 7.8%, P < 0.001) were significantly higher in obese than non-obese women. 1 year after SAGB, BMI significantly decreased from 43.3 +/- 6.9 to 34.5 +/- 7.4 (P < 0.001). HOMA index showed a significant dramatic breakdown (4.2 +/- 2.0 vs 2.4 +/- 1.0, P < 0.001). The prevalence of the metabolic syndrome declined significantly (58.8% vs 21.6%, P < 0.001). Our study shows that in severely obese women, insulin-resistance and the prevalence of the metabolic syndrome significantly decrease 1 year after SAGB. Our findings indicate that SAGB could be a useful tool to reduce the global cardiovascular risk in severely obese people and to improve their long-term prognosis.

Markers of chronic inflammation and obesity: a prospective study on the reversibility of this association in middle-aged women undergoing weight loss by surgical intervention.

Human adipose tissue expresses and releases proinflammatory cytokines and these measures of chronic inflammation have recently been associated with obesity. To test whether the proinflammatory state is reversible in subjects undergoing weight loss by surgical measures. Twenty morbidly obese women participated in this prospective study. Subjects were examined for fat mass, high-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) before and 1 y after Swedish adjustable gastric banding. Anthropometric measures displayed a significant reduction of the body mass index (BMI) from 41.6+/-5.4 to 30.8+/-6.1 kg/m(2) and the fat mass from 53.9+/-10.3 to 29.8+/-12.1 kg (mean+/-s.d.). Hs-CRP levels decreased significantly from 1.33+/-1.21 mg/dl in pre-gastric banding subjects to 0.40+/-0.61 mg/dl in post-gastric banding subjects, respectively. IL-6 and TNF-alpha levels did not differ significantly between pre- and post-gastric banding subjects. We speculate that in these patients the marked reduction in C-reactive protein might be beneficial in reducing their cardiovascular risk and is not solely mediated by IL-6 and TNF-alpha.

Early results of laparoscopic swedish adjustable gastric banding for morbid obesity

AIMS: Gastric bypass and vertical banded gastroplasty (VBG) are currently the most commonly performed bariatric procedures but neither are ideal. The results of the first 56 patients who had laparoscopic Swedish adjustable gastric banding (SAGB) are presented. METHODS: All patients referred for bariatric surgery were considered for SAGB. Each was given the alternative of gastric bypass. Patients with a body mass index of less than 35, large hiatus hernia, under 18 years of age, gastric pathology and significant psychiatric illness were excluded. Preoperative gastroscopy, ultrasonographic examination of the gallbladder and specialist anaesthetic assessment were arranged. All but five patients had attempted laparoscopic procedures. Patients were discharged when they were mobile and could tolerate 1500 ml fluid per day. Patients were given a liquidized diet for 6 weeks. Assessments were made at 6 weeks and 3, 6, 9 and 12 months. RESULTS: Some 56 consecutive patients were followed for up to 12 months. The conversion rate fell from 52 per cent for the first 25 patients to 20 per cent for the last 20. Conversion rates were higher in men and in superobese patients. The duration of a laparoscopic operation fell significantly with experience but was still significantly longer than that of an open procedure (P < 0.004). The length of hospital stay was significantly shorter for laparoscopic procedures (P < 0.001). There was no death and little morbidity. Two bands had to be removed (easily) by open surgery, one for infection and one for a recurrence of gastric herniation. The mean excess weight loss was 60 per cent at 12 months. Greater than 50 per cent of excess body-weight was lost by 48 per cent of patients at 6 months and 69 per cent at 12 months. Band adjustments in most patients achieved further weight loss to compensate for late pouch dilatation. Most failures were in patients who failed to attend. CONCLUSION: SAGB appears to have many advantages over gastric bypass and VBG; it avoids stapling the stomach, should not cause any malabsorption, can be performed laparoscopically, is adjustable, is more readily reversed (if necessary) and, therefore, has the potential for lower associated morbidity and mortality rates. In terms of excess weight loss, the early results are certainly as good, if not better, than those of gastric bypass and VBG.

Retrospective analysis of laparoscopic gastric banding technique: short-term and mid-term follow-up.

Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications. In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II. The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.