Swedish Adjustable Gastric Banding Research Articles

The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity — Weight loss, complications, pouch volume, and stoma diameter in a four-year follow-up

Background: We have developed an adjustable gastric band in which the stoma diameter can be adjusted from the outside. The aim of this study was to evaluate the new standardized operating technique with our band in terms of weight loss and complication rate. Another aim of this study was to investigate the changes in pouch volume with time and the relationship between pouch volume and stoma diameter, and subsequent weight loss following the placement of the Swedish Adjustable Gastric Band (SAGB). Methods: Between August 1990 and November 1991, 50 patients (15 men and 35 women) were operated on by laparotomy. Mean preoperative weight was 134 (106–181) kg and the mean BMI was 46 (33–59) kg/m2. During endoscopy, pouch volume was estimated according to a standardized classification system, and the stoma diameter was measured using balloon catheters. Results: At follow-up, mean weight was 80 kg and mean BMI was 27.5 kg/m2. The patients had lost a mean of 54 kg. 2 patients (4%) had abdominal reoperation because of technical problems. There was 1 incisional hernia and 1 minor wound infection, but no other significant complications. We found that pouch volume was of crucial importance. If the pouch is small enough, regulation of the stoma diameter is an important tool for steering weight loss dynamics. If the pouch is too big, further narrowing of the stoma will not lead to additional weight loss. Conclusions: This relatively simple method appears to be at least as good as the other operations, and weight loss can be adjusted to patient comfort. Currently, the procedure is being performed laparoscopically.

The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year experience and a 4-year follow-up of patients operated with a new adjustable band.

We have developed an adjustable gastric band in which the stoma diameter can be adjusted from the outside. A standardized technique was employed and the application of our band in terms of weight loss and complication rate was evaluated Between August 1990 and November 1991, 50 patients (15 men and 35 women) were operated on by laparotomy. Their mean age at surgery was 41 (19-60) years. Mean preoperative weight was 134 (106-181) kg and the mean BMI was 46 kg/m2 (range 33-59 kg/m2). No patient was lost to follow-up. Four were excluded from the study (brain tumor, pregnancy and two reoperations). The remaining 46 were followed for at least 4 years. At follow-up, mean weight was 80 kg and mean BMI was 27.5 kg/m2. The patients had lost a mean of 54 kg. Two patients (4%) had abdominal reoperation because of technical problems. There was one incisional hernia and one minor wound infection, but no other significant complications. This relatively simple method appears to be at least as good as the other operations, and weight loss can be adjusted to patient comfort. Currently, the procedure is being performed laparoscopically.

Swedish adjustable gastric banding: a preliminary experience.

The authors have been performing bariatric surgery for 15 years; since February 1992 they have carried out laparoscopic gastric banding (LGB) with a silastic band. Good experience with the LGB combined with everyday laparoscopic activity in their institution persuaded them to try laparoscopic placement of the Swedish adjustable gastric band (SAGB). The surgical procedure is the same as that for laparoscopic gastric banding except for the use of a 15 mm trocar that is required to introduce the band, and the need to place a port that is connected to the band via a wide loop tube; the port is place subcutaneously and is supported by the lower part of the sternum. The authors do not use any abdominal drain nor a naso-gastric tube. At surgery the band is left empty, and filling is usually not started until 4 weeks after surgery. The patient is immediately mobilized and begins a liquid diet the evening after the operation. The patients are usually discharged from hospital on the first postoperative day. Over 8 months, 24 patients underwent SAGB, with mean BMI 44.69 and mean operating time 45 minutes (range 30-75). No early complications occurred. Preliminary results in this small series show BMIs of 38.65 and 34.60 at 3 and 6 months postoperation. SAGB appears for be a good method for obesity surgery. It is easy to perform and is associated with a low operative risk. Provided that the band is put in the right place, weight loss can be adjusted to patient comfort.

Invited Commentary: Swedish Adjustable Gastric Banding

Invited Commentary: Swedish Adjustable Gastric Banding

Validation of Pouch Size Measurement Following the Swedish Adjustable Gastric Banding Using Endoscopy, MRI and Barium Swallow.

BACKGROUND: Pouch volume appears to be of major importance for subsequent weight loss following any gastric restriction type of surgery for morbid obesity. In order to be able to evaluate pouch volume following Swedish Adjustable Gastric Banding (SAGB), an endoscopic pouch volume classification system was designed in which pouch volume is classified in five categories. The aim of this study was to validate the endoscopic classification system using MRI and barium swallow as reference methods for pouch volume measurement. METHODS: Twenty patients (13 women and seven men) were operated for obesity with SAGB. They were investigated a mean of 3 years (6 weeks-5.5 years) after surgery and had at that time lost a mean of 60 (12-112) kg. During the same afternoon they sequentially underwent endoscopy, MRI and barium swallow with an empty stomach. RESULTS: The mean pouch volume measured with MRI was 70 ml (0-1 80 ml) and with barium swallow was 72 ml (0-1 95 ml). In 17/20 patients the volume as measured by MRI and barium swallow was in the same volume category as with endoscopy. The correlation measured according to Pearson was significant between endoscopy on one hand and MRV barium swallow both independently and together (p < 0.001). CONCLUSION: Based on these results we are confident in using our endoscopic classification system for postoperative follow-up of pouch volume.

Pouch Volume, Stoma Diameter and Weight Loss in Swedish Adjustable Gastric Banding (SAGB).

BACKGROUND: Weight loss appears to be inversely related to pouch volume following gastric restriction procedures for morbid obesity. The aim of this study was to investigate the changes in pouch volume with time and the relationship between pouch volume and stoma diameter and subsequent weight loss following the Swedish Adjustable Gastric Banding (SAGB). METHODS: During 1990 50 patients were operated upon. Their mean BMI at surgery was 46 and at 2 years 28. We followed these patients with endoscopy at 6 weeks and 3, 18 and 24 months after surgery. During endoscopy pouch volume was estimated according to a standardized classification system and measured stoma diameter using balloon catheters. RESULTS: The results indicate that the pouch dilates during the first few months after surgery but that the size thereafter is fairly stable. There is also a relationship between pouch volume and subsequent weight loss. Pouch volume seems to be the primary determinator for weight loss. CONCLUSION: The smaller the pouch the greater the weight loss. Reduction of the stoma diameter is a good instrument for regulating the degree and speed of weight loss in patients with small pouches, but much less powerful in patients with large pouches.