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Binjaloud A, Alotaibi A, Alsubhi S, Altamimi A, Nafea O, Al Yousef Z. Retrieval of Gastric Band Eroding Into the Stomach: A Gastrointestinal Fistula Case Managed Through a Combined Laparoscopic and Colonoscopic Approach. Cureus 2024; 16:e53846. [PMID: 38465116 PMCID: PMC10924469 DOI: 10.7759/cureus.53846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Obesity is an important public health concern worldwide. In Saudi Arabia, the overall prevalence of obesity has increased in both men and women in recent decades. The laparoscopic approach to bariatric surgery was first reported in the 1990s, with laparoscopic adjustable gastric banding (LAGB) developed soon after. The performance of bariatric procedures has increased rapidly in recent years, with safety and efficacy data available for the surgical treatment of obesity and related metabolic disorders. Herein, we report a challenging condition of a female patient who underwent LAGB insertion in 2013. The patient presented with a complaint of a foreign body passing through her rectum during defecation that was manually pushed back by the patient. Radiological imaging and upper/lower endoscopy confirmed the diagnosis of complete gastric band erosion into the stomach, and the reservoir with the remaining tube was observed inside the colon near the splenic flexure. This case was complicated by complete band erosion and gastrointestinal (GI) fistula formation following the delivery of her second child in January 2022. Colonic band erosion is a rare complication of LAGB. Most patients with gastric band erosion are asymptomatic or exhibit nonspecific symptoms. The definitive management of gastric band erosion involves band removal. Several approaches are commonly used in clinical practice. In our case, the band was removed using a combined laparoscopic and endoscopic retrieval approach, which is the first such report in the literature.
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Affiliation(s)
- Ahmed Binjaloud
- Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Ahad Alotaibi
- Department of General Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Samar Alsubhi
- Department of Surgery, King Fahad Medical City, Riyadh, SAU
| | - Anfal Altamimi
- Department of General Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Osamah Nafea
- Department of Surgery, Dallah Hospital, Riyadh, SAU
| | - Zeyad Al Yousef
- Department of General Surgery, King Abdulaziz Medical City, Riyadh, SAU
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Aili A, Li X, Abudureyimu K. Intra-jejunal migration with intestinal obstruction and perforation after gastric banding: A case report. Heliyon 2023; 9:e20756. [PMID: 37860574 PMCID: PMC10582381 DOI: 10.1016/j.heliyon.2023.e20756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Laparoscopic adjustable gastric banding (LAGB) is an approved procedure in bariatric surgery. However, serious complications due to band erosion have been reported. There have been few reports of intestinal obstruction and perforation caused by gastric banding invading the gastric wall and migrating to the jejunum. Case introduction: A 56-year-old man was admitted to our hospital with right lower abdominal pain ten years after LAGB surgery. An intraoperative gastric band showed erosion of the gastric wall and movement down to the jejunum, resulting in intestinal obstruction and jejunal perforation. Conclusion: Patients should undergo regular outpatient gastroscopic follow-up after gastric band surgery to prevent serious complications.
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Affiliation(s)
- Aikebaier Aili
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Institute of General Surgery and Minimally Invasive Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Clinical Research Center for Gastroesophageal Reflux Disease, Weight Loss and Metabolic Surgery, Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
| | - Xin Li
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Graduate School of Xinjiang Medical University, Urumqi 830054, China
| | - Kelimu Abudureyimu
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Institute of General Surgery and Minimally Invasive Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Clinical Research Center for Gastroesophageal Reflux Disease, Weight Loss and Metabolic Surgery, Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
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3
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Kapralou AN, Chrousos GP. Metabolic effects of truncal vagotomy when combined with bariatric-metabolic surgery. Metabolism 2022; 135:155263. [PMID: 35835160 DOI: 10.1016/j.metabol.2022.155263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Bariatric-metabolic surgery (BMS) in patients with obesity frequently leads to remission of concurrent type 2 diabetes mellitus (T2DM), even before body weight loss takes place. This is probably based on the correction of a dysmetabolic cycle in the gastrointestinal physiology of T2DM that includes increased vagus-dependent exocrine pancreatic secretion (EPS) and, hence, amplified digestion and nutrient absorption. The resultant chronic exposure of tissues to high plasma levels of glucose, fatty acids and amino acids causes tissue resistance to the actions of insulin and, at a later stage, β-cell dysfunction and reduction of insulin release. We hypothesize that the addition of a surgical truncal vagotomy (TV) may improve and solidify the beneficial results of BMS on T2DM by stably decreasing EPS, - hence reducing the digestion and absorption of nutrients -, and increasing incretin secretion as a result of increased delivery of unabsorbed nutrients to the distal intestine. This hypothesis is supported by surgical data from gastrointestinal malignancies and peptic ulcer operations that include TV, as well as by vagal blockade studies. We suggest that TV may result in a stable reduction of EPS, and that its combination with the appropriate type of BΜS, may enhance and sustain the salutary effects of the latter on T2DM.
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Affiliation(s)
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Majdoubeh Y, Abu Hassan F, Abu Alhalawa M, Aljobouri S. Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e29704. [PMID: 36321050 PMCID: PMC9616345 DOI: 10.7759/cureus.29704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Worsening hiatus hernia (HH) symptoms have been well recognized as a complication of gastric banding, however, it has not yet been explored whether gastric banding plays a role in the development of HH de novo in patients undergoing gastric banding. From the 696 studies identified, five studies met the eligibility criteria and were included. Data was extracted from PubMed, Embase, Medline, HMIC, and Web of Science databases. The pooled complication rate was evaluated along with 95% confidence intervals (95% CIs). The meta-analysis was performed using the Cochrane RevMan tool (Cochrane, London, UK). Heterogeneity was tested using the I2 index for each outcome. All the included studies assessed HH incidence among followed-up patients who needed a re-operation for upper gastrointestinal symptoms. Between-study variability was high (I2 = 94%, Chi2 = 68.92, df = 4, < 0.00001, Tau2=1.91). Complication rate ranged between 0.24% to 5.55%; pooled complication rate was 2.17% CI 95% (0.90 - 3.44%) P = 0.0008. The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least. Further research is needed to underpin the mechanism and confirm causation. However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.
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Soprani A, Zulian V, Nedelcu M, Carandina S. One-stage conversion of laparoscopic adjustable gastric banding to laparoscopic one anastomosis gastric bypass: a single center experience on 1,000 patients at 5 years of follow-up. Surg Obes Relat Dis 2022; 18:650-657. [DOI: 10.1016/j.soard.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
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Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Obesity is a civilization disease that promotes the emergence and development of many diseases, such as type II diabetes, cardiovascular, and some cancers. It directly affects the length and quality of life. The purpose of this retrospective study was to show the short- and long-term results of weight loss after laparoscopic adjustable gastric banding (LAGB) as well as to assess the results of the procedure and the percentage of reoperations. Case series analysis included 228 subsequent patients who underwent LAGB due to obesity. In the postoperative period, there was a gradual reduction in body weight, especially in the first 24 months after surgery. After 3 years, no further weight reduction was observed, and sometimes, a slight increase in weight was observed 5 years after surgery; the trend in weight reduction over the entire time period was significant. A similar result was found for percentage of BMI loss (%BMIL) and percentage of excess body weight loss (%EWL), especially in the first 36 months after surgery. Our study confirmed the good early results and low effectiveness of laparoscopic adjustable gastric banding in the long-term treatment of pathological obesity. On the other hand, the simplicity and safety of the procedure, the minimal effects of malnutrition, the low number of early complications, and the total reversibility or conversion procedure for any other bariatric surgery are the strengths of laparoscopic adjustable gastric banding for a selected group of patients.
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The Outcomes of Revisional One Anastomosis Gastric Bypass Versus Revisional Roux-en-Y Gastric Bypass After Primary Restrictive Procedures: A Prospective Nonrandomized Comparative Study. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Petrucciani N, Martini F, Benois M, Kassir R, Boudrie H, Van Haverbeke O, Hamid C, Juglard G, Costa G, Debs T, Liagre A. Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches. Obes Surg 2021; 31:5330-5341. [PMID: 34609712 PMCID: PMC8595146 DOI: 10.1007/s11695-021-05728-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB. MATERIALS AND METHODS We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed. RESULTS Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches. CONCLUSION OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, via di Grottarossa 1035-9, 00189, Rome, Italy.
| | - Francesco Martini
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Marine Benois
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Hubert Boudrie
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Celine Hamid
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gildas Juglard
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gianluca Costa
- Division of General Surgery, Campus Bio-Medico Hospital, Rome, Italy
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Arnaud Liagre
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
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Pereira A, Pinho AC, Sousa HS, da Costa EL, Rodrigues S, Barbosa E, Preto J. How Far Can Our Expectations Go on Revisional Bariatric Surgery After Failed Adjustable Gastric Banding? Obes Surg 2021; 31:1603-1611. [PMID: 33438161 DOI: 10.1007/s11695-020-05167-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Bariatric surgery has proven its effectiveness in the treatment of obesity and related comorbidities. However, several procedures may be required to treat this chronic disease and/or complications after bariatric surgery. The most frequent revisional surgeries performed after failed laparoscopic adjustable gastric banding (AGB) have been Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to compare medium-term outcomes of primary and revisional bariatric procedures. MATERIAL AND METHODS Single institution, matched case-control study of obese patients submitted to bariatric surgery, divided into four groups of 50 patients: (A) primary RYGB; (B) primary SG; (C) revisional Roux-en-Y gastric bypass (rRYGB) after failed laparoscopic AGB; (D) revisional sleeve gastrectomy (rSG) after failed laparoscopic AGB. Demographic variables, surgical procedures characteristics and complications, weight loss outcomes and resolution of comorbidities were compared. RESULTS Mortality and morbidity were comparable between primary and revisional procedures. Weight loss outcomes were inferior in patients submitted to rRYGB when compared to those submitted to RYGB, with no significant differences found when comparing the other groups. Regarding comorbidities' outcomes, only patients submitted to rSG had lower odds of comorbidities' improvement. Patients submitted to rRYGB had an odd 7 times higher of comorbidities' improvement than those submitted to rSG, independent of weight loss outcomes. CONCLUSION Revisional surgeries are safe procedures with adequate weight loss outcomes in this difficult set of patients. The choice of revisional procedure may not influence weight loss outcomes, but rRYGB seems to be a better option regarding comorbidities' resolution.
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Affiliation(s)
- André Pereira
- General Surgery Department, São João University Medical Center, Porto, Portugal. .,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.
| | - André Costa Pinho
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Hugo Santos Sousa
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Eduardo Lima da Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Sara Rodrigues
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
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Mansour S, Borzellino G, Kluger Y, Khuri S. Unexpected Gastrointestinal Tract injury years following Laparoscopic Adjustable Gastric Banding. Int J Surg Case Rep 2020; 77:412-417. [PMID: 33221568 PMCID: PMC7689376 DOI: 10.1016/j.ijscr.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022] Open
Abstract
Although most complications following LAGB are confined to the stomach and port site, some may envolve the entire bowel causing extensive damage. One must be wary of the presentation of long term complications, as it may initially present as an unrelated pathology, such as acute pancreatitis. Long term complications may be asymptomatic for years despite extensice damage, including multiple contained perforations. The surgical procedure performed to treat long term complications should be planned and performed by physicians experienced in foregut surgery.
Introduction Band migration is a late complication of Laparoscopic Adjustable Gastric Banding insertion, although rare it could be life threatening presenting as peritonitis secondary to gastro-intestinal tract injuries. A case of an unexpected extension of severe gastro-intestinal tract injuries secondary to intra-gastric migration and distal band dislocation is reported. Presentation of case A 53 years old male, with a history of laparoscopic gastric banding 15 years before and known erosion of the band into the gastric lumen was admitted for abdominal pain and raised serum amylase. Imaging revealed dislocation of the band down to the jejunum. Endoscopy and exploratory surgery showed severe decubitus pressure on the gastric antrum up to the duodenum as well as on the pancreas due to rod-like effect of the gastric band catheter and multiple sites of perforation on distal duodenum and small bowel proximal to the band, which migrated within the lumen until 90 cm distal to the Treitz ligament. Extended distal gastrectomy and resection of distal duodenum and small bowel extended to the proximal affected small bowel were necessary. Digestive tract was restored by a gastro-jejunostomy and duodeno-jejunostomy in a Roux-En-Y configuration with duodenal stump closure on tube duodenostomy. A post-operative leakage from the duodenal stump was treated conservatively and the patient was discharged on post-operative day 21. Discussion Erosion and migration of the band within the digestive lumen is one of the less frequent late complications occurring after LAGB, furthermore, the amount of extensive damage reported in this case presentation has yet to be reported in literature. Conclusion Migration of the band should be considered in the differential diagnosis of abdominal complain in patients with adjustable gastric banding. Such a complication could be severe, and lesions may have unexpected extension requiring complex surgical approach.
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Affiliation(s)
- Subhi Mansour
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel.
| | | | - Yoram Kluger
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel; HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
| | - Safi Khuri
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel; HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
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Alratrout H, Almuttawa A, Siciliano I, Keller P. Laparoscopic Roux-en-Y Gastric Bypass for Failed Gastric Banding: One-Step or Two-Step Revisional Surgery? Obes Surg 2020; 31:646-653. [DOI: 10.1007/s11695-020-05027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
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Oberlin P, de Peretti C. Bariatric Surgery in France from 1997 to 2018. Surg Obes Relat Dis 2020; 16:1069-1077. [PMID: 32660800 DOI: 10.1016/j.soard.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery is 1 of the major treatments of obesity. OBJECTIVES This study describes the development of the bariatric surgery in France and look at some factors of this evolution. SETTING It concerns the activity of all the French hospitals over a 22-year period. METHODS Hospitalization databases from 1997 to 2018 have been used to study the evolution of the number of bariatric operations, their types, the characteristics of both patients and hospitals performing this surgery. RESULTS The number of operations grew from 2800 in 1997 to 52,500 in 2018, with 2 interruptions in this growth, in 2002 and from 2017 to date. The rate of operations is 4 times higher for women than for men, with a peak in the 35-44 age group. The adjustable gastric banding was the most popular operation until 2010, then replaced by sleeve gastrectomy since 2010. Private for-profit hospitals carried out the majority of these operations, even if the public hospitals activity progressed regularly during the past 2 decades. CONCLUSIONS Compared to other countries, the rate of bariatric operations in France is rather high whereas the obesity rate is medium to low. Easy accessibility to bariatric surgery should play a role in the high rate, but specific studies are necessary to evaluate if the operations are delivered adequately to the obese population.
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Affiliation(s)
- Philippe Oberlin
- Bureau État de Santé de la Population, Direction de la Recherche, de l'Evaluation, des Études et des Statistiques, Ministère Chargé des Solidarités et de la Santé, Paris, France.
| | - Christine de Peretti
- Bureau État de Santé de la Population, Direction de la Recherche, de l'Evaluation, des Études et des Statistiques, Ministère Chargé des Solidarités et de la Santé, Paris, France
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Abstract
PURPOSE Erosion of a laparoscopic adjustable gastric band (LAGB) is a devastating problem. There is no clear evidence in literature to guide the choice of revisional procedure following an eroded LAGB. The purpose of this study is to analyse the largest series of erosions following LAGB published to-date with an aim to share our experience with this rare complication and how we managed this cohort of patients following explantation of their LAGB. MATERIALS AND METHODS This is a retrospective cohort study. Patient data is maintained prospectively in a surgical database. The study period was from January 1996 to January 2019. The outcomes of patients who underwent an erosion of LAGB were studied. RESULTS Gastric band erosion was encountered in 4.7% of patients. Sixty patients opted for a revisional procedure which included 37 repeat LAGBs, 6 laparoscopic sleeve gastrectomies (LSG), 7 Roux-en-Y gastric bypasses (RYGB), 1 intragastric balloon, and 9 failed revisional procedures. Re-erosions were noted in 27% of patients who underwent a repeat gastric banding. Median %TWL at a 1-year follow-up was significantly higher in LSG and RYGB groups compared with that in LAGB (P < 0.008 and P < 0.000, respectively). There was no significant difference between the LSG and RYGB groups. CONCLUSION The risk of re-erosion is increased in patients who undergo repeat AGB following a previous episode of erosion. Repeat LAGB should not be offered after a previous erosion. LSG and RYGB should be considered as appropriate revisional procedures in a patient who experience weight regain following explantation of an eroded LAGB.
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14
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Furbetta N, Cervelli R, Furbetta F. Laparoscopic adjustable gastric banding, the past, the present and the future. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S4. [PMID: 32309408 PMCID: PMC7154322 DOI: 10.21037/atm.2019.09.17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The laparoscopic implantation of an adjustable gastric banding (LAGB) was first described in 1993. Thereafter, the LAGB underwent to a lot of modifications, revision and refinements to become as it is currently defined. This procedure quickly became one of the most common bariatric surgical operations in the world in the first decade of the 2000s but, over the last few years, it has turned into the fourth more common procedure. A series of more or less clear reasons, led to this decrease of LAGB. The knowledge of the history of the LAGB, of its evolution over the years and its limitations can be the key-point to recognize the reasons that are leading to its decline. The adjustability and the absolute reversibility characteristic of LAGB, make this surgical procedure a “bridge treatment” to allow the specific goal of eradicating obesity.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Rosa Cervelli
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Francesco Furbetta
- General and Laparoscopic Surgery, Leonardo Clinic, Sovigliana-Vinci (Florence), Italy
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15
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Shetty NS, Ghosh G, Wan D. Gastric erosion in laparoscopic gastric banding. Scand J Gastroenterol 2020; 55:256-257. [PMID: 32027516 DOI: 10.1080/00365521.2020.1722739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Naman S Shetty
- Department of Medicine, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Gaurav Ghosh
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - David Wan
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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16
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Fares MY, Dimassi Z, Fares J, Musharrafieh U. Peroneal neuropathy and bariatric surgery: untying the knot. Int J Neurosci 2020; 130:417-423. [DOI: 10.1080/00207454.2019.1694926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mohamad Y. Fares
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zakia Dimassi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Umayya Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Jeong Y, Lee J, Kim KA, Park CM. Medical Devices of the Abdomen and Pelvis and Their Complications: A Radiologic Atlas. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:863-885. [PMID: 36238189 PMCID: PMC9432218 DOI: 10.3348/jksr.2020.81.4.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/30/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
Abstract
의료기구들이 발달하면서 복부 및 골반 내에 이식되거나 거치되는 의료기구들이 다양해졌다. 흔하게 사용되는 기구들의 영상의학 소견은 영상의학과 의사들에게 매우 익숙하지만, 상대적으로 사용 빈도가 낮거나 새로운 형태의 기구들의 영상의학 소견은 잘 알려져 있지 않다. 또한 환자에 대한 임상정보가 제한적일 경우 이런 새로운 형태의 의료기구들은 잘못 해석되거나 놓치기 쉽다. 그러므로 복부 및 골반 내 의료기구들의 영상의학 소견을 인지하는 것은 기구들의 올바른 위치를 평가하고, 이와 관련된 합병증을 평가하는데 있어 매우 중요하다. 본 논문에서는 다양한 복부 및 골반 내 의료기구들과 이와 관련된 합병증의 영상의학 소견을 소개하고자 한다.
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Affiliation(s)
- Yaewon Jeong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Min Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Patel G, Tase A, Caplin S, Barry J. Public cost of privately inserted laparoscopic adjustable gastric bands. BJS Open 2019; 3:314-316. [PMID: 31183447 PMCID: PMC6551392 DOI: 10.1002/bjs5.50141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/13/2018] [Indexed: 12/04/2022] Open
Abstract
Background Laparoscopic 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. Methods All 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. Results A 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). Conclusion The 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.
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Affiliation(s)
- G Patel
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - A Tase
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - S Caplin
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - J Barry
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
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19
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Kang SH, Park YS, Ahn SH, Park DJ, Kim HH. Laparoendoscopic Single-Site Bariatric Surgery: A Review of Single-Port Laparoscopic and Endoscopic Bariatric Treatments. J Obes Metab Syndr 2018; 27:25-34. [PMID: 31089537 PMCID: PMC6489492 DOI: 10.7570/jomes.2018.27.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022] Open
Abstract
Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m2, height of more than 180 cm, and xiphoid–umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure’s role in the growth of bariatric surgery.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Hota P, Caroline D, Gupta S, Agosto O. Laparoscopic adjustable gastric band erosion with intragastric band migration: A rare but serious complication. Radiol Case Rep 2017; 13:76-80. [PMID: 29487641 PMCID: PMC5826467 DOI: 10.1016/j.radcr.2017.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 01/26/2023] Open
Abstract
Although laparoscopic adjustable gastric banding is considered the most minimally invasive surgical technique for the treatment of morbid obesity, the procedure has a reported overall complication rate of up to 26%. Among the various complications, gastric band erosion with intragastric band migration is the most worrisome because of the risk of subsequent obstruction, peritonitis, and sepsis. Therefore, prompt and accurate diagnosis is crucial during imaging evaluation of these patients in the late postoperative setting. In this article, we report a case of a 47-year-old woman with a gastric band that had eroded into the gastric wall with intragastric migration demonstrating classic findings on fluoroscopic and computed tomography imaging.
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Affiliation(s)
- Partha Hota
- Division of Abdominal Imaging, Department of Radiology, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140, USA
| | - Dina Caroline
- Division of Abdominal Imaging, Department of Radiology, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140, USA
| | - Sonia Gupta
- Division of Abdominal Imaging, Department of Radiology, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140, USA
| | - Omar Agosto
- Division of Abdominal Imaging, Department of Radiology, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140, USA
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21
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Carandina S, Tabbara M, Galiay L, Polliand C, Azoulay D, Barrat C, Lazzati A. Long-Term Outcomes of the Laparoscopic Adjustable Gastric Banding: Weight Loss and Removal Rate. A Single Center Experience on 301 Patients with a Minimum Follow-Up of 10 years. Obes Surg 2017; 27:889-895. [PMID: 27699566 DOI: 10.1007/s11695-016-2391-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is a chronic disease that requires procedures to enable to maintain good long-term results. Laparoscopic adjustable gastric banding (LAGB) studies with a long-term follow-up are limited and have often given conflicting results. We report our results in terms of banding life span and weight loss in a cohort of 301 patients operated on LAGB with a minimum follow-up of 10 years. METHODS All patients who underwent LAGB at our university hospital between 1998 and 2004 were included in this study. The main outcome was band survival and complications that led to band removal, and the secondary outcome was weight loss. We present raw data and data after imputation for patients lost at follow-up. RESULTS Most patients were women (83 %), and the mean body mass index (BMI) baseline was 45.2 ± 6.7. The pars flaccida technique was performed in 50.9 % of the patients. All patients had at least 10 years of follow-up (range 10-16 years). Data were available at 10 years for 79.7 % and at 15 years for 80.6 %. Band survival was 65.8 % at 10 years and 53.3 % at 15 years. Mean excess weight loss (EWL) at 5, 10, and 15 years was 41.4, 38.7, and 35.1 %, respectively. CONCLUSION Despite the encouraging short-term results, LAGB shows long-term disappointing results in terms of weight loss and complication rates. The removal rate increases with time (about 3-4 % per year), and at 15 years, almost half of the bands had been removed.
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Affiliation(s)
- Sergio Carandina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France.
| | - Malek Tabbara
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Leila Galiay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Claude Polliand
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Daniel Azoulay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of HPB Surgery and Liver Transplant Unit, Henri Mondor University Hospital-Creteil Hospital, Université Paris-Est Creteil Val de Marne, Avenue du Maréchal de Lattre de Tassigny-Avenue de Verdun,, 94000, Creteil, France
| | - Christophe Barrat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Andrea Lazzati
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of HPB Surgery and Liver Transplant Unit, Henri Mondor University Hospital-Creteil Hospital, Université Paris-Est Creteil Val de Marne, Avenue du Maréchal de Lattre de Tassigny-Avenue de Verdun,, 94000, Creteil, France
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Abstract
Obesity and its association with long-term health problems constitutes one of the major challenges in medicine. Though diet regulation and exercise are the primary treatment strategies, surgery is the most reliable long-term solution. Although bariatric surgical complications continue to decline, prompt recognition is essential to optimize patient outcomes. Despite their relative rarity, it is important to recognize thoracic complications, as several of these can result in severe morbidity and mortality. This article describes common bariatric surgical procedures performed, their expected postoperative appearances, and intrathoracic complications.
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Bilkhu A, Harvey H, Davies JB, Steward MA, Halstead JC. Laparoscopic repair of a migrated adjustable gastric band connecting tube with colonic erosion. J Surg Case Rep 2017; 2017:rjx089. [PMID: 28584623 PMCID: PMC5451660 DOI: 10.1093/jscr/rjx089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/12/2017] [Indexed: 01/07/2023] Open
Abstract
Laparoscopic adjustable gastric bands are a popular and effective surgical option to treat morbid obesity. The overall complication rate is 10–20% and the most common complication is of ‘slippage’. Although other complications such as gastric band migration and erosion have been reported, the phenomenon of a migrated gastric band connecting tube eroding into the colon (after port removal) is seldom reported in the literature. In this article we describe such a case of an incidentally found colonic erosion on colonoscopy and describe the subsequent laparoscopic repair, as well as a review of the literature.
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Affiliation(s)
- Amarvir Bilkhu
- Bradford Teaching Hospitals NHS Trust, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Hannah Harvey
- Bradford Teaching Hospitals NHS Trust, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Justin B Davies
- Bradford Teaching Hospitals NHS Trust, Duckworth Ln, Bradford BD9 6RJ, UK
| | - Mark A Steward
- Bradford Teaching Hospitals NHS Trust, Duckworth Ln, Bradford BD9 6RJ, UK
| | - James C Halstead
- Bradford Teaching Hospitals NHS Trust, Duckworth Ln, Bradford BD9 6RJ, UK
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24
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Abstract
The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight-loss programs, nutrition and dietary supplements, prescription and over-the-counter medications, and health clubs. Another approximately dollars 100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short-term morbidities and long-term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.
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Affiliation(s)
- Scott A Shikora
- Tufts University School of Medicine, Bariatric Surgery, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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25
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Choi YB. Current Status of Bariatric and Metabolic Surgery in Korea. Endocrinol Metab (Seoul) 2016; 31:525-532. [PMID: 27834081 PMCID: PMC5195828 DOI: 10.3803/enm.2016.31.4.525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 01/27/2023] Open
Abstract
Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. In Korea, surgery for morbid obesity was laparoscopic sleeve gastrectomy first performed in 2003. Since 2003, the annual number of bariatric surgeries has markedly increased, including adjustable gastric banding (AGB), Roux-en-Y gastric bypass, sleeve gastrectomy, mini-gastric bypass, and others. In Korea, AGB is much more common than in others countries. A large proportion of doctors, the public, and government misunderstand the necessity and effectiveness of bariatric surgery, believing that bariatric surgery has an unacceptably high morbidity, and that it is not superior to non-surgical treatments to improve obesity and obesity-related diseases. The effectiveness, safety, and cost-effectiveness of bariatric surgery have been well demonstrated. The Korean Society of Metabolic and Bariatric Surgery recommend bariatric surgery confining to morbidly obese patients (body mass index ≥40 or >35 in the presence of significant comorbidities).
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Affiliation(s)
- Youn Baik Choi
- Department of Surgery, Chung Hospital, Seoul, Korea.
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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Tolone S, Savarino E, Yates RB. The impact of bariatric surgery on esophageal function. Ann N Y Acad Sci 2016; 1381:98-103. [PMID: 27304195 DOI: 10.1111/nyas.13107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/24/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023]
Abstract
Obesity is a worldwide epidemic. There is increasing evidence that obesity is associated with benign gastroesophageal disease, including gastroesophageal reflux disease (GERD) and esophageal dysmotility. Bariatric surgery-including sleeve gastrectomy, gastric bypass, and adjustable gastric band placement-can effectively result in weight loss and control of obesity-related conditions, including GERD. However, there is increasing evidence that bariatric surgery itself can have a deleterious effect on esophageal function. In this review, we address the effect of obesity and bariatric surgery on esophageal dysfunction.
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Affiliation(s)
- Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Robert B Yates
- UW Surgical Services and Hernia Center, Center for Esophageal and Gastric Surgery, Department of Surgery, University of Washington, Seattle, Washington
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Zampieri N, Castellani R, Francia L. Is There Still a Role for Video-Assisted Laparoscopic Gastric Banding in Severe Obesity? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicola Zampieri
- Department of Surgery, University of Verona, AOUI, Verona, Italy
| | - Roberto Castellani
- Department of Surgery, Casa di Cura San Francesco Hospital, Verona, Italy
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Fournier P, Gero D, Dayer-Jankechova A, Allemann P, Demartines N, Marmuse JP, Suter M. Laparoscopic Roux-en-Y gastric bypass for failed gastric banding: outcomes in 642 patients. Surg Obes Relat Dis 2016; 12:231-9. [DOI: 10.1016/j.soard.2015.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 01/01/2023]
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O’Brien P. Bariatric outcomes and the three-legged stool. Surg Obes Relat Dis 2016; 12:156-7. [DOI: 10.1016/j.soard.2015.10.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/24/2022]
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30
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Subcutaneous placement of lap band port without fascial fixation provides safe and durable access. Obes Surg 2015; 24:1987-91. [PMID: 24825600 DOI: 10.1007/s11695-014-1286-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band access port has been routinely sutured to the anterior fascia of the abdominal wall using nonabsorbable sutures. We present our technique demonstrating that nonfascial fixation with using a mesh allows for a safe and durable placement of the port in the superficial subcutaneous tissue. METHODS Retrospective chart review included 102 consecutive patients who had Lap band surgery performed by single surgeon (EA) from June 2011 until April 2013. The port was sutured to a piece of polypropylene mesh and tunneled in the subcutaneous tissue away from the incision. Patients' demographics were analyzed as well as the following parameters: OR time for port placement, follow-up, port complications requiring revision, difficult access facilitated by fluoroscopy imaging, port infection, and skin erosion. RESULTS The study included 102 consecutive patients (23 males and 79 females), mean age was 49 years old, mean weight was 284.7 lb, mean height was 66.2 in., and mean body mass index (BMI) was 46.3 kg/m(2). The average operative time for port placement was 4 min, mean follow-up was 12 months, port complications occurred in 2 % of the patients while fluoroscopy for difficult port access was required in 3 %. No cases of port infections or skin erosions occurred. CONCLUSIONS Superficial subcutaneous placement of Lap Band Port using mesh fixation without anchoring the port to the fascia provides safe and durable access. Deep incisions to secure the port directly to the fascia might not be necessary.
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31
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Beitner MM, Ren-Fielding CJ, Fielding GA. Reducing complications with improving gastric band design. Surg Obes Relat Dis 2015; 12:150-6. [PMID: 26802223 DOI: 10.1016/j.soard.2015.08.520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 08/03/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adjustable gastric bands have undergone significant design changes since their introduction. Band diameter, balloon volume, and shape have been modified to create high balloon fill volumes but lower and more evenly distributed pressure on the upper stomach. There have been few comparative studies on complication rates with different band types. OBJECTIVES To compare complication rates among different types of adjustable gastric bands at a single institution. SETTING University-affiliated hospital, United States. METHODS We performed a retrospective cohort study of adult patients with a body mass index ≥ 35.0 kg/m(2) who underwent laparoscopic adjustable gastric banding from January 1, 2001 to December 31, 2007 and were followed for at least 5 years. Primary outcomes of the analysis were complications requiring operative management at our institution within the first 5 years after initial band placement. Reoperative procedures included diagnostic laparoscopy, hiatal hernia repair, band repositioning, replacing the band, removing the band, and converting to another bariatric procedure. RESULTS For this study, 2711 patients met the inclusion criteria-1827 (67.4%) women and 884 (32.6%) men. Bands initially implanted included first-generation bands, LAP-BAND™ 9.75 cm (24.0%), 10 cm (33.9%) and Vanguard (24.8%) and second-generation bands, AP standard (9.5%) and AP large (7.9%). Four hundred and eighty-five patients experienced complications requiring reoperation. The 5-year follow-up rate was 63.3%. In the first 5 postoperative years there were significantly fewer complications with second-generation bands (10.0% versus 19.5%, P<.0001). Smaller, older bands had the highest complication rates (LAP-BAND 9.75 cm, 28.2%) and complication rates decreased with each successive model. Rates of band removal were not different between first- and second-generation bands. The rate of multiple complications was low at 1.5%. CONCLUSION First-generation bands are associated with higher complication rates. Our study found that complication rates decreased with each successive model. We can expect that future design modifications will continue improve the performance with the adjustable gastric band.
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Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated? World J Surg 2015; 39:2000-5. [DOI: 10.1007/s00268-015-3036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Comparison of percentage excess weight loss after laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Wideochir Inne Tech Maloinwazyjne 2014; 9:351-6. [PMID: 25337157 PMCID: PMC4198654 DOI: 10.5114/wiitm.2014.44257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/15/2013] [Accepted: 01/23/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35-55 kg/m(2). AIM The aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery. MATERIAL AND METHODS Two hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 ±11.9 and 39.4 ±10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m(2) and 45.2 kg/m(2), p = NS. RESULTS The mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40-49.9 kg/m(2) in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50-55 kg/m(2) there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality. None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients. CONCLUSIONS During the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time.
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The Effect of Weight Loss on the Cardiac Structure and Function After Laparoscopic Adjustable Gastric Banding Surgery in Morbidly Obese Individuals. Obes Surg 2014; 24:1961-8. [DOI: 10.1007/s11695-014-1294-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270:327-41. [PMID: 24471382 DOI: 10.1148/radiol.13122520] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology, VCU Medical Center, Richmond, VA (L.R.C.)
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Le Page PA, Kwon S, Lord SJ, Lord RV. Esophageal dysmotility after laparoscopic gastric band surgery. Obes Surg 2013; 24:625-30. [PMID: 24258146 DOI: 10.1007/s11695-013-1134-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of the laparoscopic adjustable gastric band (LAGB) on the esophagus has been the subject of few studies despite recognition of its clinical importance. The aim of this study was to investigate the frequency and clinical effect of esophageal dysmotility and dilatation after LAGB. METHODS We undertook a retrospective analysis of 50 consecutive patients with no dysmotility on perioperative video contrast swallow who underwent primary LAGB operation. All patients had serial focused postoperative contrast studies for band adjustments at least 6 months post-LAGB. Clinical and radiological outcomes were assessed. RESULTS Median follow-up time was 18 months (range 7-39 months), and the median number of contrast swallows per patient was 5. The mean excess weight loss (EWL) overall was 47 % (standard deviation (SD) 22.3). Radiological abnormalities were recorded in 17 patients (34 %, 95 % confidence interval (CI) 21-49 %), of whom 15 had radiological dysmotility and 7 had esophageal dilatation (five patients had both dysmotility and dilatation). Of these 17 patients, six (35 %) developed significant symptoms of dysphagia, gastroesophageal reflux disease (GERD) or regurgitation requiring fluid removal. In comparison, 12 of 33 (36 %) patients without radiological abnormalities developed symptoms requiring fluid removal (p = 1.00). Patients with radiological abnormalities were significantly older than those without these abnormalities. Symptoms were alleviated by removing fluid in most patients. CONCLUSIONS The LAGB operation results in the development of radiological esophageal dysmotility in a significant proportion of patients. It is not clear if these changes are associated with an increased risk of significant symptoms. Fluid removal can reverse these abnormalities and their associated symptoms.
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Affiliation(s)
- Philip A Le Page
- Department of Upper Gastrointestinal Surgery, St. Vincent's Hospital, Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia,
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Moon RC, Teixeira AF, Jawad MA. Conversion of failed laparoscopic adjustable gastric banding: Sleeve gastrectomy or Roux-en-Y gastric bypass? Surg Obes Relat Dis 2013; 9:901-7. [DOI: 10.1016/j.soard.2013.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 12/20/2022]
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Brown JJS, Boyle M, Mahawar K, Balupuri S, Small PK. Laparoscopic adjustable gastric band survival in a high-volume bariatric unit. Br J Surg 2013; 100:1614-8. [DOI: 10.1002/bjs.9284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Although laparoscopic adjustable gastric bands (LAGBs) have been shown to be efficacious, their long-term usefulness has been questioned. This study examined the fate of LAGBs in a unit with over a decade of experience in their use. Patient factors related to the need for, and timing of, band removal were investigated.
Methods
A prospectively maintained database was used to identify all patients with a LAGB. Patient demographics, need for band removal and band survival were examined. Logistic regression modelling was done and Kaplan–Meier curves were calculated for band survival.
Results
Between 2000 and 2012, 674 bands were placed in 665 patients. Of these, 143 (21·2 per cent) were removed. There was no difference in rates of removal by sex (P = 0·910). The highest rates of removal were in patients aged less than 40 years (26·7 per cent), and those with a BMI greater than 60 kg/m2 (28·6 per cent). Earlier band removal was seen in younger patients (P = 0·002). Rates of removal increased linearly by earlier year of placement. Of bands placed 4 or more years previously, 35·0 per cent required removal. Eighty-three patients (58·0 per cent) who had a LAGB removed went on to have a further bariatric procedure (band to bypass, 66; band to sleeve, 17).
Conclusion
Even in experienced hands LAGB does not appear to be a definitive solution. In a large number of patients there appears to be a finite ‘band life’, with the majority of patients requiring conversion to a further bariatric procedure.
Presented in part to a meeting of the British Obesity and Metabolic Surgery Society, Glasgow, UK, January 2013, as an oral presentation for which it was awarded the council prize; published in abstract form as Br J Surg 2013; 100(Suppl 3): 2
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Affiliation(s)
- J J S Brown
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - M Boyle
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - K Mahawar
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - S Balupuri
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
| | - P K Small
- Bariatric Surgery Unit, Sunderland Hospital, Sunderland, UK
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Gero D, Dayer-Jankechova A, Worreth M, Giusti V, Suter M. Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®. Obes Surg 2013; 24:114-22. [DOI: 10.1007/s11695-013-1074-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fridman A, Moon R, Cozacov Y, Ampudia C, Lo Menzo E, Szomstein S, Rosenthal RJ. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg 2013; 217:614-20. [PMID: 23890844 DOI: 10.1016/j.jamcollsurg.2013.05.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our objective was to ascertain procedure-related morbidity among laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) patients. These are the 3 most common bariatric procedures performed worldwide. We reviewed our experience since the introduction of LSG and compared the procedure-related morbidity among all 3 procedures. STUDY DESIGN We conducted a retrospective review of a prospectively collected database of all morbidly obese patients who underwent bariatric surgery between the years 2005 and 2011. We identified and compared complications, mortality, readmissions, and reoperations in patients who underwent LRYGB, LAGB, and LSG. RESULTS A total of 2,199 bariatric procedures were performed during this period of time. Of those procedures, 1,327 were LRYGB, 619 were LSG, and 253 were LAGB. Perioperative mortality was not applicable for all 3 procedures. The leak rate was 0.5% for LRYGB and 0.3% for LSG, and was not applicable for LAGB. The average number of readmissions postoperatively was less than 2 times for all 3 procedures: LRYGB 1.96 times, LSG 1.49 times, and LAGB 1.54 times. The percentages of procedures requiring reoperations due to complications or failures were 14.6% in the LAGB group, 6.6% in the LRYGB group, and 1.8% in the LSG group. CONCLUSIONS In short- and mid-term follow-up, LSG appears to have the lowest procedure-related morbidity when compared with LRYGB and LAGB.
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Affiliation(s)
- Abraham Fridman
- The Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic, Weston, FL
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Revisional surgery after failed adjustable gastric banding: institutional experience with 90 consecutive cases. Surg Endosc 2013; 27:4044-8. [PMID: 23836121 DOI: 10.1007/s00464-013-3056-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/09/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Revisional surgery may be required in a high percentage of patients (up to 30 %) after laparoscopic adjustable gastric banding (LAGB). We report our institutional experience with revisional surgery. METHODS From January 1996 to November 2011, 90 patients underwent revisional surgery after failed LAGB. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were proposed. In the presence of gastroesophageal reflux disease, esophageal dysmotility, hiatal hernia, or diabetes, RYGB was preferentially proposed. RESULTS In two cases, revisional surgery was aborted due to local severe adhesions. Eighty-eight patients (74 females; mean age 42.79 ± 10.03 years; mean BMI 44.73 ± 6.19 kg/m(2)) successfully underwent revisional SG (n = 48) or RYGB (n = 40). One-stage surgery was performed in 29 cases. Follow-up rate was 78.2 % (n = 61) and 40.9 % (n = 36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage) was observed. Overall postoperative excess weight loss (%EWL) was 31.24, 40.92, 52.41, and 51.68 % at 3, 6, 12, and 24 months of follow-up respectively. There was a statistically significant higher %EWL at 1 year in patients <50 years old (55.9 vs. 41.5 % in patients >50 years old; p = 0.01), of female gender (55.22 vs. 40.73 % in male; p = 0.04), and in patients in which the AGB was in place for <5 years (57.09 vs. 47.43 % if >5 years p = 0.02). CONCLUSIONS Revisional surgery is safe and effective. Patients <50 years, of female gender, and with the AGB in place for <5 years had better %EWL after revisional surgery.
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Victorzon M, Tolonen P. Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis 2013; 9:753-7. [PMID: 24079901 DOI: 10.1016/j.soard.2013.05.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/08/2013] [Accepted: 05/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many studies of short-term to mid-term outcomes after laparoscopic adjustable gastric banding (LAGB) have been published, but reliable long-term outcome reports with a minimum follow up ≥ 10 years in a sufficient number of included patients are still scarce. The objective of this study was to evaluate the long-term results after LAGB. METHODS Sixty consecutive patients (44 women, 16 men) were treated for morbid obesity by LAGB between 1996 and 1999. Median age of the patients at the time of operation was 45 years (range 21-64). Median preoperative body mass index (BMI, kg/m(2)) was 45 (range 35-55). All patients were asked to adhere to a strict follow-up program. Patients' BMI and percentage excess weight loss (%EWL) were calculated in the hospital's database for bariatric patients, and excess weight was taken as the weight in kilograms above the weight at BMI of 25 kg/m(2). RESULTS Complete data on all 60 patients could be assessed; thus, the overall rate of follow-up was 100%. After a median (range) follow-up of 14.1 years (13.2-16.8 years), the mean BMI (SD) dropped from 45 (5) to 36 (6) kg/m(2), with a mean (SD) EWL of 49% (29). At 15 years of follow-up, 29 (48%) bands have been removed, and 38 (63%) reoperations have been performed in 29 (48%) patients. Almost 70% received further treatment for their morbid obesity after band removal. Of those patients with the band still in place at 14 years, 40% had more than 50% EWL and 20% had less than 25% EWL. There was no mortality related to the primary or revisional operations, but 2 patients died of unrelated causes. CONCLUSIONS Mean %EWL after LAGB after more than 14 years was fairly good-49%. However, a reoperation rate of more than 60% in 48% of the patients and a band removal rate of almost 50% may indicate that LAGB cannot be recommended as a primary procedure to the general morbidly obese population.
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Affiliation(s)
- Mikael Victorzon
- Department of Abdominal and Minimally Invasive Surgery, Vaasa Central Hospital, Vaasa Hospital District, Finland; University of Turku, Vaasa Central Hospital, Turku, Finland.
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Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 2013; 257:87-94. [PMID: 23235396 DOI: 10.1097/sla.0b013e31827b6c02] [Citation(s) in RCA: 352] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the long-term outcomes after laparoscopic adjustable gastric banding (LAGB) and compare these with the published literature on bariatric surgery. BACKGROUND Because obesity is a chronic disease, any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective. Yet for bariatric surgery, few long-term weight loss data are available. We report our 15-year follow-up data after LAGB and provide a systematic review of the peer-reviewed literature for weight loss at 10 years or more after bariatric surgical procedures. METHODS We performed a prospective longitudinal cohort study of LAGB patients using an electronic database system (LapBase) to track progress, measure weight changes, and document revisional procedures. The evolution of the LAGB procedure was recognized, and revisional rates for 3 separate periods between September 1994 and December 2011 were described. In addition, we performed a systematic review of the peer-reviewed published literature collecting all reports that included weight loss data at or beyond 10 years. RESULTS A total of 3227 patients, with a mean age of 47 years and a mean body mass index of 43.8 kg/m, were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. Follow-up was intact in 81% of patients overall and 78% of those beyond 10 years. There was no perioperative mortality for the primary placement or for any revisional procedures. There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. Revisional procedures were performed for proximal enlargement (26%), erosion (3.4%), and port and tubing problems (21%). The band was explanted in 5.6%. The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years. The revision group showed a similar weight loss to the overall group beyond 10 years. The systematic review of all bariatric procedures with 10 or more years of follow-up showed greater than 50% EWL for all current procedures. The weighted mean at maximum follow-up for LAGB was 54.2% EWL and for Roux-en-Y gastric bypass was 54.0% EWL. CONCLUSIONS The LAGB study from 1 center demonstrates a durable weight loss with 47% EWL maintained to 15 years. This weight loss occurred regardless of whether any revisional procedures were needed. A systematic review shows substantial and similar long-term weight losses for LAGB and other bariatric procedures.
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Vu L, Switzer NJ, De Gara C, Karmali S. Surgical interventions for obesity and metabolic disease. Best Pract Res Clin Endocrinol Metab 2013; 27:239-46. [PMID: 23731885 DOI: 10.1016/j.beem.2012.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity continues to be a growing problem in both the developed and the developing world. Its strong link with co-morbid conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, and depression presents an increasing strain on health care systems around the world. Diet and exercise alone has been shown to be largely ineffective at managing obesity. Surgery is the only evidence-based method of allowing morbidly obese patients to lose weight and to maintain this weight loss. Weight-reduction in obese individuals from bariatric surgery has also been found to markedly improve obesity-related co-morbid conditions, particularly, type 2-diabetes. Diabetic remission from bariatric surgery has resulted in the inclusion of bariatric surgery, by the International Diabetes Taskforce, as a treatment modality for type-2 diabetes. This consensus statement named four surgical options that have been found to be effective in both weight-loss and in inducing diabetes remission. These four surgical procedures lead to weight-loss through restrictive and malabsorptive mechanisms. Each specific operation has a different level of efficacy in inducing weight-loss and diabetic remission, as well as distinct types and rates of complications. This article reviews the best evidence that exists for the effectiveness and complications of these four operations.
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Affiliation(s)
- Lan Vu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Batchelder AJ, Williams R, Sutton C, Khanna A. The evolution of minimally invasive bariatric surgery. J Surg Res 2013; 183:559-66. [PMID: 23522984 DOI: 10.1016/j.jss.2013.02.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/03/2013] [Accepted: 02/19/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity is a pandemic associated with significant morbidity and mortality. This historical article charts the progress of successful strategies that have been used to tackle weight loss from dietary modifications to the development of surgical interventions that have subsequently evolved. It also provides a précis of the reported outcome data following minimally invasive bariatric procedures. METHODS A literature review was performed. All articles relevant to the progression of bariatric surgery and minimally invasive surgery were assessed, as were those articles that described the ultimate evolution, combination, and establishment of the two techniques. RESULTS This article charts the progression of early weight loss strategies, from early dietary modifications and pharmacologic interventions to initial techniques in small bowel bypass procedures, banding techniques, and sleeve gastrectomies. It also describes the simultaneous developments of endoscopic interventions and laparoscopic procedures. CONCLUSIONS A range of procedures are described, which differ in their success in terms of loss of excess weight and in their complication rates. Weight loss is greatest for biliopancreatic diversion followed by gastric bypass and sleeve gastrectomy and least for adjustable gastric banding. Bariatric surgery is an evolving field, which will continue to expand given current epidemiologic trends. Developments in instrumentation and surgical techniques, including single access and natural orifice approaches, may offer further benefit in terms of patient acceptability.
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Lago Oliver J, Vázquez Amigo S, Sánchez García J, Pedraza Toledo G, Mercader Cidoncha E, Sanz Sánchez M, Turégano Fuentes F. [Adjustable gastric band as surgical treatment for morbid obesity. Are worldwide results reproducibles in Spain?]. Cir Esp 2013; 91:301-7. [PMID: 23477446 DOI: 10.1016/j.ciresp.2012.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/28/2012] [Accepted: 08/13/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adjustable gastric banding is a surgical technique used all over the world for the treatment of morbid obesity. In Spain, the number of patients treated with adjustable gastric banding is far lower than the average worldwide average. A number of reasons have been put forward to explain this difference. MATERIAL AND METHODS A program of bariatric surgery by means of implantation of an adjustable gastric banding was started in 2001, together with a dedicated follow-up protocol in order to prevent complications and improve results. RESULTS A total of 132 patients were operated on between 2001 and 2011. The mean age of the 102 female and 30 male patients was 39 years, and the mean body mass index was 43. Follow-up was longer than 5 years in 61 patients, while the mean follow-up in the rest was 44.4 months. There was no mortality or severe morbidity. Eight patients (6.06%) underwent reoperation, 3 of them for complications related to the reservoir, 4 for slipping of the band, and one for erosion. One slipped band was removed, and a new one (of the Lap Band type) was inserted. Three slipping bands were converted to other techniques. The percentage excessive body weight loss was maintained in 54.8% of the patients followed-up for longer than 5 years. CONCLUSIONS The results of our series are comparable to those reported in the literature and show that, provided that a close follow-up, like that performed by most groups, is implemented, adjustable gastric banding can also be a safe and effective bariatric surgery technique in our country.
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Zijlstra H, Larsen JK, Wouters EJ, van Ramshorst B, Geenen R. The Long-Term Course of Quality of Life and the Prediction of Weight Outcome After Laparoscopic Adjustable Gastric Banding: A Prospective Study. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hanna Zijlstra
- Department of Nutrition and Dietetics, School of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eveline J.M. Wouters
- Department of Allied Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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High Risks for Adverse Outcomes After Gastric Bypass Surgery Following Failed Gastric Banding. Ann Surg 2013; 257:279-86. [DOI: 10.1097/sla.0b013e3182683037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Angrisani L, Cutolo PP, Formisano G, Nosso G, Vitolo G. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis 2013; 9:405-13. [PMID: 23453785 DOI: 10.1016/j.soard.2012.11.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/05/2012] [Accepted: 11/30/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to compare outcomes of patients randomly assigned to undergo LAGB or LRYGB at 10 years. METHODS LAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 ± 8.9 years; range 20-49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women; mean age 33.3 years; mean weight 120 kg; mean body mass index [BMI] 43.4 kg/m(2)) or LRYGB (n = 24, 4 men and 20 women; mean age 34.7; mean weight 120 kg; mean BMI 43.8 kg/m(2)). Data on complications, reoperations, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. The data were analyzed using Student's t test and Fisher's exact test, with P<.05 considered significant. RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients. Reoperations were required in 9 (40.9%) of 22 LAGB patients and in 6 (28.6%) of the 21 LRYGB patients. At 10-year follow-up, the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients (69±29% versus 46±27%; P = .03). CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results (76.2% versus 46.2%) at 10 years. However, LRYGB exposes patients to higher early complication rates than LAGB (8.3% versus 0%) and potentially lethal long-term surgical complications (internal hernia and bowel obstruction rate: 4.7%).
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Affiliation(s)
- Luigi Angrisani
- General and Laparoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy.
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O'Brien P. Comment on: Outcome of laparoscopic adjustable gastric banding and the prevalence of band revision and explantation at academic centers: 2007-2009. Surg Obes Relat Dis 2012; 8:727-8. [DOI: 10.1016/j.soard.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/03/2011] [Indexed: 11/15/2022]
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