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Chen S, Chiang J, Ghanem O, Ferzli G. Decision-making Considerations in Revisional Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:400-406. [PMID: 38963277 DOI: 10.1097/sle.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE With drastic variations in bariatric practices, consensus is lacking on an optimal approach for revisional bariatric surgeries. MATERIALS AND METHODS The authors reviewed and consolidated bariatric surgery literature to provide specific revision suggestions based on each index surgery, including adjustable gastric band (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single anastomosis duodenal-ileal bypass with sleeve (SADI-S), one anastomosis gastric bypass (OAGB), and vertical banded gastroplasty (VBG). RESULTS AGB has the highest weight recurrence rate and can be converted to RYGB, SG, and BPD-DS. After index SG, common surgical options include a resleeve or RYGB. The RYGB roux limb can be distalized and pouch resized in context of reflux, and the entire anatomy can be revised into BPD-DS. Data analyzing revisional surgery after a single anastomosis duodenal-ileal bypass with sleeve was limited. In patients with one anastomosis gastric bypass and vertical banded gastroplasty anatomy, most revisions were the conversion to RYGB. CONCLUSIONS As revisional bariatric surgery becomes more common, the best approach depends on the patient's indication for surgery and preexisting anatomy.
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Affiliation(s)
- Sheena Chen
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Omar Ghanem
- Department of General Surgery, Mayo Clinic, Rochester, MN
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
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2
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Aiolfi A, Sozzi A, Bonitta G, Bona D, Bonavina L. Foregut Erosion Related to Biomedical Implants: A Scoping Review. J Laparoendosc Adv Surg Tech A 2024; 34:691-709. [PMID: 39102627 DOI: 10.1089/lap.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Introduction: Biomedical devices implanted transabdominally have gained popularity over the past 50 years in the treatment of gastroesophageal reflux disease, paraesophageal hiatal hernia, and morbid obesity. Device-related foregut erosions (FEs) represent a challenging event that demands special attention owing to the potential of severe postoperative complications and death. Purpose: The aim was to provide an overview of full-thickness foregut injury leading to erosion associated with four types of biomedical devices. Methods: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, EMBASE, and Web of Science databases were queried until December 31, 2023. Eligible studies included all articles reporting data, management, and outcomes on device-related FE. Results: Overall, 132 articless were included for a total of 1292 patients suffering from device-related FE. Four different devices were included: the Angelchik antireflux prosthesis (AAP) (n = 25), nonabsorbable mesh for crural repair (n = 60), adjustable gastric banding (n = 1156), and magnetic sphincter augmentation device (n = 51). The elapsed time from device implant to erosion ranged from 1 to 480 months. Most commonly reported symptoms were dysphagia and epigastric pain, while acute presentation was reported rarely and mainly for gastric banding. The technique for device removal evolved from more invasive open approaches toward minimally invasive and endoscopic techniques. Esophagectomy and gastrectomy were mostly reported for nonabsorbable mesh FE. Overall mortality was .17%. Conclusions: Device-related FE is rare but may occur many years after AAP, nonabsorbable mesh, adjustable gastric banding, and magnetic sphincter augmentation implant. FE-related mortality is infrequent, however, increased postoperative morbidity and the need for esophagogastric resection were observed for nonabsorbable mesh-reinforced cruroplasty.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Andrea Sozzi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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3
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Field X, Pullman J, French R. Surgical Management of Gastrocolic Fistula Formation Due to Simultaneous Gastric and Colonic Erosion of Laparoscopic Adjustable Gastric Band: a Case Report. Obes Surg 2023; 33:4165-4167. [PMID: 37889367 DOI: 10.1007/s11695-023-06845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Xavier Field
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand.
| | - Jack Pullman
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Rowan French
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand
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Sujka J, McEwen C, Sandhu M, Sunderland M, Mhaskar R, Mooney A, DuCoin C. Staple Line Bacterial Load May Not Be a Contra-Indication to Magnetic Sphincter Augmentation Placement During Primary Sleeve Gastrectomy. Obes Surg 2023; 33:3703-3705. [PMID: 37792251 DOI: 10.1007/s11695-023-06869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida, Tampa, FL, USA.
| | - Courtney McEwen
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- University of South Florida College of Medicine, Tampa, FL, USA
| | | | - Rahul Mhaskar
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Ashley Mooney
- Department of Surgery, University of South Florida, Tampa, FL, USA
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5
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Faust TF, Schnittka E, Steadman MB, Cail GM, Rice BS. Management of Laparoscopic Adjustable Gastric Band Erosion: A Case Report. Cureus 2023; 15:e47718. [PMID: 38021841 PMCID: PMC10675987 DOI: 10.7759/cureus.47718] [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] [Received: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Gastric banding was one of the first operations to gain popularity within the field of bariatric surgery. This case details one patient's presentation and subsequent management of gastric band erosion with the hope of guiding other physicians and supporting the decreased use of gastric banding. The patient, a 61-year-old Caucasian female, presented to the bariatric clinic complaining of a multiyear history of epigastric pain and acid reflux, which was refractory to treatment with proton pump inhibitors. She had a history of laparoscopic adjustable gastric band (LAGB) placement in 2007. She was initially successful in achieving weight loss and maintained regular band adjustments but was lost to follow-up and regained a body mass index (BMI) of 41.59 kg/m2. Evaluation with upper gastrointestinal (GI) endoscopy was recommended and performed. This revealed a LAGB in its entirety with tubing within the gastric fundus. Removal with dual endoscopy and abdominal laparoscopy was recommended and scheduled. During attempts to remove the band using an endoscopic snare, significant difficulty was encountered. Ultimately, an endoscopic rat-tooth grasper was used to lyse the band and tubing into four sections for complete removal. The subcutaneous port of the band was successfully removed laparoscopically, and the patient was discharged from the operating room. She reported limited pain in the postoperative suite but was lost to follow-up regarding long-term symptom relief. This report describes the presentation and management of one patient's experience with a known complication of LAGB-band erosion. This complication necessitated two additional procedures with anesthesia and placed the patient at increased risk for esophageal perforation, complications related to sedation, and the development of abdominal adhesions. Her case aims to support the decreasing prevalence of LAGBs within bariatric surgery and hopes to guide other physicians challenged with the management of similar cases.
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Affiliation(s)
- Taylor F Faust
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Emma Schnittka
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Michael B Steadman
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Garrett M Cail
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Bradley S Rice
- Department of Gastroenterology, Crestwood Medical Center, Huntsville, USA
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6
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Endoscopic Gastric Band Removal. J Clin Med 2023; 12:jcm12020617. [PMID: 36675548 PMCID: PMC9867319 DOI: 10.3390/jcm12020617] [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] [Received: 11/14/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB) procedures have declined worldwide in recent years. A known complication is the intraluminal erosion of the prosthetic material. The endoscopic management of gastric band erosion represents the recommended approach nowadays, and it avoids any additional trauma to the gastric wall already damaged by the migration. The purpose of our study was to assess the feasibility of endoscopic management for intraluminal gastric band erosion following LAGB. METHODS From January 2009-December 2020, a total of 29 patients were retrospectively reviewed after undergoing endoscopic gastric band removal. The study included all consecutive patients who underwent endoscopic gastric band removal in this period. No patients were excluded from the study. Data on patient demographic characteristics, case history, operative details (procedural time, adverse events), and complications were reviewed retrospectively. RESULTS Twenty-nine patients underwent endoscopic gastric band removal: 22 women (75.8%) with a mean age of 45 years (range: 28-63) and mean Body Mass Index (BMI) of 31 ± 4.7 kg/m2 (range: 24-41). The average time to the identification of erosion after LAGB was 42 months (range: 28-137). The initial upper endoscopy found a migrated band of more than half of the diameter in 21 cases, less than a half but more than a third in seven cases and in one case, less than a third (use of a stent). Twenty-seven patients were successfully treated with endoscopic removal, and in two cases, the endoscopic approach failed, and laparoscopy was further performed. CONCLUSIONS The endoscopic management of intraluminal erosion after LAGB can be safe and effective and should be considered the procedure of choice when treating this complication. The percentage of the band migration is important for the timing of the endoscopic removal.
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7
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American Society of Metabolic and Bariatric Surgery Consensus Statement on Laparoscopic Adjustable Gastric Band Management. Surg Obes Relat Dis 2022; 18:1120-1133. [DOI: 10.1016/j.soard.2022.06.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
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8
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Antozzi L, Antozzi P, Baroni L, Renda P, Antozzi M, Glujoy MR. Esophageal Erosion of Adjustable Gastric Band, Endoscopic Solution of an Unreported Complication. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34665650 DOI: 10.1089/lap.2021.0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although laparoscopic adjustable gastric band (LAGB) placement appears as a safe and reproducible procedure, serious complications can occur. We present a patient with fever, dysphagia, epigastric pain, and port site inflammation. Esophagogastroduodenoscopy and computed tomography (CT) scan diagnosed esophageal erosion of the gastric band. An endoscopic retrieval was proposed to avoid accessing the abdominal cavity and mediastinum, reduce recovery time, and minimize complications. The patient successfully underwent the procedure with immediate improvement of symptoms and discharge on the seventh postoperative day. This article aims to report the first clinical case of an esophageal erosion of LAGB completely treated with an endoscopic approach.
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Affiliation(s)
| | | | - Leticia Baroni
- Department of Gastroenterology, Hospital Privado del Sur, Bahia Blanca Argentina
| | - Pedro Renda
- Centro de Cirugías Especiales, Bahía Blanca, Argentina
| | - Mario Antozzi
- Centro de Cirugías Especiales, Bahía Blanca, Argentina
| | - Macarena R Glujoy
- Department of Surgery, Hospital Italiano Regional del Sur, Bahía Blanca, Argentina
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9
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Alam F, Ng S, Farooq D, Haque A, Payne R. Late gastric band erosion mimicking diverticulitis and sepsis. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fahreyar Alam
- Department of General Surgery Great Western Hospital Swindon UK
| | - Sherwin Ng
- Department of General Surgery Great Western Hospital Swindon UK
| | - Dilawar Farooq
- Department of General Surgery Great Western Hospital Swindon UK
| | - Ali Haque
- Department of General Surgery Great Western Hospital Swindon UK
| | - Richard Payne
- Department of General Surgery Great Western Hospital Swindon UK
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10
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Robinson TJ, Soriano C, Larsen M, Mallipeddi MK, Hunter JA, Chang L. Endoscopic removal of eroded laparoscopic adjustable gastric bands: a preferred approach. Surg Obes Relat Dis 2020; 16:1030-1034. [PMID: 32540149 DOI: 10.1016/j.soard.2020.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Complications related to laparoscopic adjustable gastric banding (LAGB) have led to an increased number of removals. An uncommon but potentially devastating complication is gastric band erosion into the gastric lumen, which can be managed by open surgical, laparoscopic, and endoscopic approaches. OBJECTIVE A wide array of management techniques has been reported for removal of LAGB that have eroded into the stomach. We describe the preferred method for successful endoscopic band removal at our institution. SETTING Community tertiary-care referral hospital accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. METHODS A single-center, retrospective review of a prospectively maintained database was used to identify patients who underwent LAGB removal from 2009 to 2019. We identified the subset of patients with band erosion. We analyzed patient characteristics, presenting symptoms, diagnostic modalities, and method of band extraction. RESULTS A total of 132 patients underwent LAGB removal, among whom 22 (16.7%) patients were diagnosed with erosion. Seven (32%) patients underwent laparoscopic removal, 14 (64%) patients underwent endoscopic removal, and 1 patient (4%) underwent combined laparoscopic and endoscopic approach. These latter patients had variable amounts of erosion and buckle visibility, but all underwent endoscopic retrieval. We found that using an endoscopic retrograde cholangiopancreatography guidewire with an endoscopic retrograde cholangiopancreatography mechanical lithotriptor for band transection and snare for retrieval have been effective. CONCLUSIONS A standardized, multidisciplinary, and minimally invasive endoscopic approach for LAGB erosion has been found to be successful without the need for further surgical intervention and may be offered to patients upon discovery of erosion.
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Affiliation(s)
- Todd J Robinson
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Celine Soriano
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Michael Larsen
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington
| | - Mohan K Mallipeddi
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Jeffrey A Hunter
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Lily Chang
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington.
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11
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Girardi V, Barone G, Gualtierotti M, De Martini P, Mutignani M, Crippa J, Ferrari G. Laparoscopic Adjustable Gastric Band: Case Report of Erosion with Intragastric Migration Requiring an Extreme Surgical Approach. Obes Surg 2020; 30:2030-2032. [PMID: 32147776 DOI: 10.1007/s11695-020-04455-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- V Girardi
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - G Barone
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - M Gualtierotti
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - P De Martini
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - M Mutignani
- Digestive and Operative Endoscopy Unit, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - J Crippa
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. .,General Surgery Residency Program, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - G Ferrari
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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12
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Bains L, Lal P, Vindal A, Gautam K. Weight Regain After LABG: Ponder to Intra-gastric Migration of Adjustable Gastric Band. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_78_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Technical Details and Result of a Minimally Invasive Management of Gastric Band Erosions: a Series of 47 Patients. Obes Surg 2019; 29:3754-3761. [PMID: 31520303 DOI: 10.1007/s11695-019-04170-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Laparoscopic adjustable gastric banding (LAGB) is proven to be a safe and effective treatment option for obesity in the long term. However, in recent decades, LAGB prevalence progressively decreased worldwide principally due to the incidence and the management of the complications. Understanding the optimal management of the complications becomes therefore of primary importance. The aim of this study is to describe a personal technical, laparoscopic solution of band erosion and to analyze outcomes in 47 patients. METHODS From October 1995 to January 2019, 3697 LAGB were performed at our institution. Since November 2011, an original laparoscopic gastric banding removal technique was introduced. All the bands placed in these patients were Lap-Band AP System (Allergan, Irvin, CA). The data of the patients who underwent gastric band removal because of band erosion were retrieved from a prospectively collected institutional database, and used for the present retrospective evaluation. RESULT Ninety-four patients (2.5% of the entire casuistic) with eroded band were diagnosed and treated at our institution. Forty-seven patients were treated with the laparoscopic gastric banding removal technique introduced in November 2011. All the operations have been performed laparoscopically with no conversion or intraoperative complications. There were neither major complications nor peri-operative (30 days) mortality. CONCLUSION Proper preoperative management and a standardized minimally invasive technique could help to cope with erosion, the most frightening complication of LAGB. Understanding the optimal management of complications and safe reoperation techniques can contribute to a rational use of the LAGB, reversing the current declining tendency.
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Gonzalez-Heredia R, Sanchez-Johnsen L, Quadri P, Bindal V, Bernstein K, Masrur M, Elli E. Reduction in Medication Use for Postrobot-Assisted Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0039] [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)
| | - Lisa Sanchez-Johnsen
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Pablo Quadri
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Vivek Bindal
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Karen Bernstein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Enrique Elli
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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15
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Novel Endoscopic Management of Eroding Laparoscopic Adjustable Gastric Band: A Case Series. Case Rep Gastrointest Med 2019; 2018:2747852. [PMID: 30693117 PMCID: PMC6332995 DOI: 10.1155/2018/2747852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022] Open
Abstract
Complications of laparoscopic adjustable gastric bands include migration and slippage of the band, dilation of the proximal gastric pouch, troublesome gastroesophageal reflux symptoms, and erosion of the stomach. The latter occurs in 0.6-12.7% of cases and necessitates removal of the band. Several open and laparoscopic surgical techniques have been described for band extraction, while fully endoscopic techniques have emerged and proven safe. Three cases of eroding gastric bands treated in a single center with fully endoscopic removal of the band are analyzed in this study. Novel use of the duodenoscope and endoscopic retrograde cholangiopancreatography instruments and accessories is described, in order to perform endoscopic division of the plastic band and retraction through the mouth. All three cases were successfully treated utilizing this novel technique. Gastric wall erosion from the band has nonspecific symptoms and various predisposing factors. Removal of the foreign material is required. Endoscopic procedures are effective in 77-92% of cases, avoiding general anaesthesia with low surgical morbidity. As a result patients are discharged early resolving quicker to a normal diet.
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16
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Cardiogastric Fistula as a Rare Complication After Gastric Banding and Hiatal Hernia Surgery. Obes Surg 2019; 29:1023-1027. [PMID: 30617915 DOI: 10.1007/s11695-018-03682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Lim R, Beekley A, Johnson DC, Davis KA. Early and late complications of bariatric operation. Trauma Surg Acute Care Open 2018; 3:e000219. [PMID: 30402562 PMCID: PMC6203132 DOI: 10.1136/tsaco-2018-000219] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 01/02/2023] Open
Abstract
Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen—acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease—for these are still among the most common etiologies of abdominal pathology in these patients.
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Affiliation(s)
- Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, Hawaii, USA
| | - Alec Beekley
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Corvini M, Kang E, Weidner G, Lombert J. Laparoscopic Adjustable Gastric Band Erosion Into the Stomach and Colon. J Osteopath Med 2018; 118:479-481. [PMID: 29946666 DOI: 10.7556/jaoa.2018.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Morbid obesity has reached epidemic proportions in the United States and constitutes a significant cause of morbidity and mortality. Bariatric surgery represents a viable and effective means of weight loss. Laparoscopic adjustable gastric band placement is the most commonly used and least invasive bariatric surgical technique. Although the complication rate is low, various complications have been described, including erosion of the gastric band into the stomach. The authors present a case of laparoscopic adjustable gastric band erosion, where both the band and the tubing eroded into the stomach and colon, and the tubing further eroded out of and back into the colon several times.
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19
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Kim SY, Oh KY, Chung JW, Kim YJ, Kim KO, Kwon KA, Park DK, Kim KK, Kim SM. Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia. Gut Liver 2018; 11:497-503. [PMID: 28335099 PMCID: PMC5491084 DOI: 10.5009/gnl16089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 10/13/2016] [Indexed: 01/16/2023] Open
Abstract
Background/Aims The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications. Methods We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment. Results Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed. Conclusions Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.
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Affiliation(s)
- Su Young Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyong Yong Oh
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun-Won Chung
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Oh Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang An Kwon
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Kyun Park
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Aneese AM, Yang SK, Cappell MS. Case Report of Successful Medical Management of Progressive Gastric Band Penetration-to-Perforation After Band Insertion at Bariatric Surgery: Documentation by 12 Serial EGDs During 50 months of Observation. Dig Dis Sci 2018; 63:257-263. [PMID: 29134298 DOI: 10.1007/s10620-017-4783-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/25/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Andrew M Aneese
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Sung K Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Mitchell S Cappell
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA. .,Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
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21
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Kordzadeh A, Lorenzi B, Kadirkamanathan S, Charalabopoulos A. Laparoscopic transgastric removal of eroding gastric band: a different approach. J Surg Case Rep 2016; 2016:rjw207. [PMID: 27915240 PMCID: PMC5159176 DOI: 10.1093/jscr/rjw207] [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] [Indexed: 11/13/2022] Open
Abstract
Gastric banding is a popular method for the treatment of morbid obesity. Amongst complications, gastric erosion remains uncommon but could prove fatal. Multiple techniques, from open surgery to endoscopic and standard laparoscopic technique for their removal, have been previously detailed in the literature. However, only a few reports have mentioned their total laparoscopic transgastric removal in the literature. Herein, we report a successful removal of an eroding gastric band with its technical suggestion in a 43-year-old female patient 22 months following its application.
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Affiliation(s)
- Ali Kordzadeh
- Department of General and Upper Gastrointestinal Surgery, Mid Essex Hospital Services NHS Trust Broomfield Hospital, Chelmsford, Essex, UK .,Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, UK
| | - Bruno Lorenzi
- Department of General and Upper Gastrointestinal Surgery, Mid Essex Hospital Services NHS Trust Broomfield Hospital, Chelmsford, Essex, UK
| | - Sritharan Kadirkamanathan
- Department of General and Upper Gastrointestinal Surgery, Mid Essex Hospital Services NHS Trust Broomfield Hospital, Chelmsford, Essex, UK
| | - Alexandros Charalabopoulos
- Department of General and Upper Gastrointestinal Surgery, Mid Essex Hospital Services NHS Trust Broomfield Hospital, Chelmsford, Essex, UK
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22
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Endoscopic removal of intrajejunal migrated gastric band. Surg Obes Relat Dis 2016; 12:e75-e76. [PMID: 27692908 DOI: 10.1016/j.soard.2016.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/15/2016] [Accepted: 08/13/2016] [Indexed: 11/21/2022]
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23
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Ramly EP, Safadi BY, Aridi HD, Kantar R, Mailhac A, Alami RS. Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database. Obes Surg 2016; 27:462-468. [DOI: 10.1007/s11695-016-2348-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Management of laparoscopic adjustable gastric band erosion. Surg Endosc 2016; 31:1505-1512. [PMID: 27553794 DOI: 10.1007/s00464-016-5183-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) was a popular procedure in the USA and Europe in the past decade. However, its use has currently declined. Band erosion (BE) is a rare complication after LAGB with a reported incidence rate of 1.46 %. Controversies exist regarding the management, approach and timing for the band removal. The aim of this study is to describe the rate, clinical presentation and perioperative outcomes of BEs at our institution and provide overall recommendations regarding the diagnosis and management of BE. MATERIALS AND METHODS This study is a single-center, retrospective review of a prospectively maintained database. Data were collected from all consecutive patients who underwent a LAGB and band revisional surgeries at the University of Illinois Hospital and Health Sciences System from December 2008 to September 2015. We identified patients who underwent gastric band removal due to a BE and analyzed their outcomes. RESULTS A total of 576 LAGBs were performed at our institution. Nine patients underwent surgery for BE at our hospital. The average time between the primary surgery and the removal of the band was 68.5 (42.9) months. Abdominal pain, nausea and/or vomiting were the most frequently mentioned symptoms. In all patients, a minimally invasive approach was used to remove the band. The mean length of hospitalization was 2.6 (1.1) days. The only complication was a pneumonia (n = 1). CONCLUSIONS BE is one of the most severe complications of LAGB. The minimally invasive approach provided us with the opportunity to repair the fistula, and it was associated with a prompt recovery with very little morbidity. In general, it is recommended that the band be removed at the time of the diagnosis of the BE. Endoscopic band removal can be utilized with patients who have a more advanced BE and migration into the gastric lumen.
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25
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Yates E, Millsap J, Blackledge C, Wang HE. Woman With Abdominal Pain. Ann Emerg Med 2016; 68:125-35. [PMID: 27343643 DOI: 10.1016/j.annemergmed.2016.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Eric Yates
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL
| | - Jessica Millsap
- Department of Radiology, University of Alabama School of Medicine, Birmingham, AL
| | - Camille Blackledge
- Department of Surgery, University of Alabama School of Medicine, Birmingham, AL
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL
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Papadimitriou G, Vardas K, Alfaras K, Alfaras P. Laparoscopic adjustable gastric band: 4-year experience and learning curve. JSLS 2016; 19:e2013.00363. [PMID: 25848174 PMCID: PMC4370035 DOI: 10.4293/jsls.2013.00363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Laparoscopic adjustable gastric banding has become the most popular procedure for the treatment of morbid obesity in Europe. The objectives of this series are to report the results of the 4-year experience of a single surgeon and to define the learning curve. Methods: A retrospective review of 156 patients who underwent laparoscopic adjustable gastric banding between October 2006 and May 2010 was performed. Patients were separated into 3 groups: group 1 comprised the first 50 patients; group 2 comprised the second 50 patients; and group 3 comprised the last group of patients, with a total of 56 patients. Results: The male-to-female ratio was 1:4 (33 male and 133 female patients). The mean age was 38 years (range, 17–62 years). The mean preoperative body mass index was 44.9 kg/m2. The mean percent excess weight loss was 41.7% at the 1-year follow-up visit (153 patients, 98%), 49.7% at the 2-year follow-up visit (147 patients, 94%), and 50.2% at the 3-year follow-up visit (127 patients, 81%). The overall complication rate and major complication rate were 15.4% and 3.2%, respectively. There were no deaths. Percent excess weight loss, length of hospitalization (in days), and complication rates were compared among the 3 groups. No significant differences were noted among the groups except in the number of complications (P < .001), but all data were clearly improved in groups 2 and 3. Conclusions: The analyses in this study have documented one more time that laparoscopic adjustable gastric banding is an effective procedure for the treatment of morbid obesity, achieving >50% excess weight loss at 3 years. It is a procedure with certain complications even when performed by a surgeon with previous experience in laparoscopic surgery. According to our subset analysis, the learning curve is at least 50 procedures.
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Affiliation(s)
- Georgios Papadimitriou
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Konstantinos Vardas
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Konstantinos Alfaras
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Panagiotis Alfaras
- First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece
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Carter CO, Fernandez AZ, McNatt SS, Powell MS. Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass. Surg Obes Relat Dis 2016; 12:572-576. [DOI: 10.1016/j.soard.2015.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Chiapaikeo D, Schultheis M, Protyniak B, Pearce P, Borao FJ, Binenbaum SJ. Analysis of reoperations after laparoscopic adjustable gastric banding. JSLS 2016; 18:JSLS.2014.00210. [PMID: 25392616 PMCID: PMC4154406 DOI: 10.4293/jsls.2014.00210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic adjustable gastric banding is considered the least invasive surgical option for the treatment of morbid obesity. Its initial popularity has been marred by recent long-term studies showing high complication rates. We sought to examine our experience with gastric banding and factors leading to reoperation. METHODS We reviewed retrospective data of 305 patients who underwent laparoscopic adjustable gastric banding between 2004 and 2011 at a single institution, 42 patients of whom required a reoperation, constituting 13.8%. Patients undergoing elective reoperations for port protrusion from weight loss as a purely cosmetic issue were excluded (n = 10). Patients' demographic data, weight loss, time to reoperation, and complications were analyzed. RESULTS Of 305 patients, 42 (13.8%) required reoperations: 26 underwent band removal (8.5%) and 16 underwent port revision (5.2%). The mean weight and body mass index for all patients who underwent reoperations were 122.6 kg and 45.0 kg/m(2), respectively. The most common complication leading to band removal was gastric prolapse (n = 14, 4.6%). The most common indication for port revision was a nonfunctioning port (n = 10, 3.3%). CONCLUSION Laparoscopic adjustable gastric banding was initially popularized as a minimally invasive gastric-restrictive procedure with low morbidity. Our study showed a 13.8% reoperation rate at 3 years' follow-up. Most early reoperations (<2 years) were performed for port revision, whereas later reoperations (>2 years) were likely to be performed for band removal. Laparoscopic adjustable gastric banding is associated with high reoperation rates; therefore bariatric surgeons should carefully consider other surgical weight-loss options tailored to the needs of the individual patient that may have lower complication and reoperation rates.
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Affiliation(s)
- David Chiapaikeo
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Molly Schultheis
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Paul Pearce
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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30
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31
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An 8-Year Experience With Endoscopic Management of Eroded Gastric Bands. Surg Laparosc Endosc Percutan Tech 2015; 25:e140-4. [DOI: 10.1097/sle.0000000000000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2015; 81:1063-72. [PMID: 25733126 DOI: 10.1016/j.gie.2014.09.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/22/2022]
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33
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Montravers P, Augustin P, Zappella N, Dufour G, Arapis K, Chosidow D, Fournier P, Ribeiro-Parienti L, Marmuse JP, Desmard M. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med 2015; 34:45-52. [DOI: 10.1016/j.accpm.2014.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
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34
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Chiapaikeo D, Schultheis M, Protyniak B, Pearce P, Borao FJ, Binenbaum SJ. Analysis of reoperations after laparoscopic adjustable gastric banding. JSLS 2014. [PMID: 25516707 PMCID: PMC4266230 DOI: 10.4293/jsls.2014.002104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives: Laparoscopic adjustable gastric banding is considered the least invasive surgical
option for the treatment of morbid obesity. Its initial popularity has been marred
by recent long-term studies showing high complication rates. We sought to examine
our experience with gastric banding and factors leading to reoperation. Methods: We reviewed retrospective data of 305 patients who underwent laparoscopic
adjustable gastric banding between 2004 and 2011 at a single institution, 42
patients of whom required a reoperation, constituting 13.8%. Patients
undergoing elective reoperations for port protrusion from weight loss as a purely
cosmetic issue were excluded (n = 10). Patients' demographic data,
weight loss, time to reoperation, and complications were analyzed. Results: Of 305 patients, 42 (13.8%) required reoperations: 26 underwent band
removal (8.5%) and 16 underwent port revision (5.2%). The mean
weight and body mass index for all patients who underwent reoperations were 122.6
kg and 45.0 kg/m2, respectively. The most common complication leading
to band removal was gastric prolapse (n = 14, 4.6%). The most common
indication for port revision was a nonfunctioning port (n = 10,
3.3%). Conclusion: Laparoscopic adjustable gastric banding was initially popularized as a minimally
invasive gastric-restrictive procedure with low morbidity. Our study showed a
13.8% reoperation rate at 3 years' follow-up. Most early reoperations
(<2 years) were performed for port revision, whereas later reoperations (>2
years) were likely to be performed for band removal. Laparoscopic adjustable
gastric banding is associated with high reoperation rates; therefore bariatric
surgeons should carefully consider other surgical weight-loss options tailored to
the needs of the individual patient that may have lower complication and
reoperation rates.
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Affiliation(s)
- David Chiapaikeo
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Molly Schultheis
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Paul Pearce
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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Musielak MC, Patel HK, Curry TW, Fegelman EJ. Laparoscopic Gastric Band Erosion: A Retrospective Analysis and Review of Management. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hiral K. Patel
- Department of Surgery, The Jewish Hospital, Cincinnati, Ohio
| | - Trace W. Curry
- Department of Surgery, The Jewish Hospital, Cincinnati, Ohio
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Gonzalez-Heredia R, Masrur M, Patton K, Bindal V, Sarvepalli S, Elli E. Revisions after failed gastric band: sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 2014; 29:2533-7. [PMID: 25427419 DOI: 10.1007/s00464-014-3995-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/04/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Laparoscopic gastric band is an appealing bariatric operation due to its simplicity and good short-term outcomes; however, it is associated with complications (slippage, erosion, prolapse) and failure in reaching target weight loss. This study describes our experience with failed gastric bands that required a revisional procedure. MATERIALS AND METHODS This single-center retrospective analysis includes all consecutive patients who underwent a gastric band removal and revisional surgery in our hospital from January 2008 to June 2014. A total of 81 patients were identified and divided in three groups: Group one included patients who just had the gastric band removed (43), group two consisted of patients who underwent a conversion to sleeve gastrectomy (SG) (26), and group three included patients who required a conversion to Roux-en Y gastric bypass (RYGB) (12). Patient demographics, date of gastric band placement, indications for revision, postoperative morbidity and mortality, operating time, blood loss, length of stay, and % excess weight loss (%EWL) were recorded. Perioperative and clinical outcomes were compared between conversions to SG and RYGB. RESULTS In group two (n = 26), 21 conversions to SG were performed in concurrence with the band removal as a one-stage operation, while five procedures were performed in two-stages. There were no complications and no case was converted to open. Patients who underwent a one-stage procedure had a longer operative time, although it did not reach statistical significance. In group three, 12 patients underwent a conversion to RYGB as a revisional operation; 11 were performed as a one-stage procedure and only one patient underwent a two-stage procedure. CONCLUSIONS SG and RYGB are safe options to revise a failed gastric band. Both groups who received either a SG or RYGB had a low complication rate and acceptable %EWL with no statistical difference between the two.
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Affiliation(s)
- Raquel Gonzalez-Heredia
- College of Medicine, University of Illinois at Chicago, 840 South Wood Street, 435 E, Chicago, IL, 60612, USA,
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Hussain AA, Nicholls J, El-Hasani SS. Laparoscopic adjustable gastric band: how to reduce the early morbidity. JSLS 2014; 18:JSLS-D-13-00241. [PMID: 25392623 PMCID: PMC4154413 DOI: 10.4293/jsls.2014.00241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic adjustable gastric band insertion is a safe weight reduction procedure, but serious complications can develop. The aim of this study was to evaluate our technique in preventing early band complications. METHODS Patients were given the choice of procedure according to body mass index, the presence of diabetes, and preference. Weight loss data were not considered, as our aim was to evaluate the morbidity of band surgery using a specific technique. A pars flaccida approach and plication technique were used for all patients. Postoperative follow-up was provided at 1 month, 2 months, and every 3 months for the first year and then yearly for a further 2 years. Thereafter, general practitioners referred patients if late complications arose. RESULTS From January 2007 to August 2011, 1149 patients (245 men [21.32%], 904 women [78.67%]) underwent laparoscopic adjustable gastric band insertion under the care of a single bariatric surgeon. Patients were hospitalized for 1 night only unless they developed early complications. The primary and secondary outcomes were major and minor band complications, respectively. Patients' age range was 18 to 64 years (mean, 44 years). Body mass index ranged from 33 to 62 kg/m2 (mean, 42 kg/m2). There were 2 band erosions (0.17%), 6 cases of band prolapse (0.52%), 4 port problems (0.34%), 1 band leak (0.08%), 3 tight bands (0.26%), 2 port infections (0.17%), and no deaths. Five procedures (0.43%) were abandoned and excluded from this study, and 1 (0.17%) was converted to minilaparotomy to control abdominal wall bleeding. The duration of follow-up ranged from 16 to 60 months. CONCLUSIONS A combined pars flaccida and plication technique is associated with a low early complication rate.
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Affiliation(s)
- Abdulzahra A Hussain
- Bariatric Unit, General Surgery Department, Princess Royal University Hospital, Orpington, Greater London, United Kingdom
| | - Jacqueline Nicholls
- Bariatric Unit, University College London Hospitals, Greater London, United Kingdom
| | - Shamsi S El-Hasani
- Bariatric Unit, General Surgery Department, Princess Royal University Hospital, Orpington, Greater London, United Kingdom
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Gastric emphysema secondary to laparoscopic gastric band erosion. Int J Surg Case Rep 2014; 5:727-30. [PMID: 25216194 PMCID: PMC4189050 DOI: 10.1016/j.ijscr.2014.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/30/2014] [Accepted: 07/30/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Gastric band erosion is a known complication of adjustable gastric band surgery. There are no previous reports of gastric band erosion associated with gastric emphysema (GE) or emphysematous gastritis (EG), a rare condition with a mortality rate exceeding 50%. PRESENTATION OF CASE We report the first known case of GE found in a 58-year-old lady presenting with acute onset epigastric abdominal pain and haematemesis in the setting of a chronically eroded gastric band. GE was visualised in the anterior gastric wall of the stomach without evidence of EG. Endoscopic and surgical examination of the stomach was undertaken along with band removal followed by defect repair. DISCUSSION GE can result from obstructive, traumatic and pulmonary causes. EG is a rare and often lethal form of GE resulting from bacterial invasion of the gastric wall through a mucosal defect leading to sepsis and gastric necrosis. Early reports documented early definitive operative debridement of necrotic gastric wall of patients with EG while recent reports have demonstrated a feasible non-operative approach among highly selected patients with no evidence of gastric necrosis. There are no previous reports on the treatment of patients with gastric band erosion and suspected EG. CONCLUSION Patients presenting acutely with symptomatic gastric band erosion, radiological evidence of GE with evidence of leucocytosis, peritonism or sepsis may develop EG. A high index of suspicion, low threshold for operative exploration and optimal management with antimicrobial therapy and close supportive care are necessary to ensure the best survival outcomes for these patients.
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Burns A, Teixeira AF, Jawad MA. Liver abscess following surgical removal of an eroded adjustable gastric band. Surg Obes Relat Dis 2014; 10:e101-3. [PMID: 24986459 DOI: 10.1016/j.soard.2014.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Amanda Burns
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
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Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band--a systematic review. Obes Surg 2014; 23:1899-914. [PMID: 23982182 DOI: 10.1007/s11695-013-1058-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The adjustable gastric band (L)AGB gained popularity as a weight loss procedure. However, long-term results are disappointing; many patients need revision to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG). The purpose of this study was to assess morbidity, mortality, and results of these two revisional procedures. Fifteen LRYGB studies with a total of 588 patients and eight LSG studies with 286 patients were included. The reason for revision was insufficient weight loss or weight regain in 62.2 and 63.9% in LRYGB and LSG patients. Short-term complications occurred in 8.5 and 15.7% and long-term complications in 8.9 and 2.5%. Reoperation was performed in 6.5 and 3.5%. Revision to LRYGB or LSG after (L)AGB is feasible and relatively safe. Complication rate is higher than in primary procedures.
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Abstract
Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques.
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Affiliation(s)
- Paulo Sakai
- Gastrointestinal Endoscopy Division, Medical School, Sao Paulo University, Sao Paulo, Brazil
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Dogan ÜB, Akin MS, Yalaki S, Akova A, Yilmaz C. Endoscopic management of gastric band erosions: a 7-year series of 14 patients. Can J Surg 2014; 57:106-11. [PMID: 24666448 DOI: 10.1503/cjs.001313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. METHODS We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter. RESULTS Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric penetration of the connecting tube broken close to the band. CONCLUSION The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.
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Affiliation(s)
- Ümit Bilge Dogan
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Salih Akin
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Serkan Yalaki
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Atilla Akova
- The Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cengiz Yilmaz
- The Department of Radiology, Adana Numune Training and Research Hospital, Adana, Turkey
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Doussot A, Poussier M, Combier C, Leung U, David M, Jouve JL, Facy O. Minimally invasive endogastric removal of migrated gastric band after endoscopic failure: how I do it. Obes Surg 2014; 24:958-60. [PMID: 24677147 DOI: 10.1007/s11695-014-1234-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intragastric band migration is a rare and late complication of laparoscopic -adjustable gastric banding and should be recognized by all digestive surgeons. Endoscopic removal is most commonly performed, but surgery is an alternative in cases of endoscopic failure. Many different procedures have been reported. We show here (see Video) a fully laparoscopic endogastric procedure through two 5-mm antral gastrotomies. This technique can also be used to remove benign endogastric tumors. The procedure is safe and provides a large endogastric operative area, with no particular morbidity. Endogastric removal through a fully laparoscopic approach should be considered as the first alternative to endoscopic approach.
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Affiliation(s)
- A Doussot
- Department of Digestive Surgical Oncology, Dijon University Hospital, 14 rue Gaffarel, 21079, Dijon, France,
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Removal of Eroded Gastric Bands Using a Transgastric SILS Device. Case Rep Surg 2014; 2013:852747. [PMID: 24455390 PMCID: PMC3876897 DOI: 10.1155/2013/852747] [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] [Received: 10/14/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Laparoscopic adjustable gastric banding (LAGB) is a popular method for the treatment of morbid obesity. One of the most feared complications is gastric band erosion which occurs with a reported incidence of 0.3 to 14%. Intragastric migrated bands are best managed by endoscopic removal. Recent case studies reported successful endoscopic removal of intragastric migrated bands, but it is not always possible. We report our first experience with a transgastric removal of eroded bands using a Single Incision Laparoscopic Surgery (SILS) device. Methods. A patient who underwent gastric banding in the past (2007) presented with symptoms of epigastric pain and weight gain. Preoperative gastroscopy revealed stomach wall erosion with the gastric band partially (2/3) migrated into the gastric lumen. Attempts to remove the band by endoscopy were not successful. A laparoscopy was performed and multiple adhesions with evidence of inflammation was seen in the upper abdomen around the band. A SILS port was inserted through a 2 cm incision in the left hypochondrium with the internal ring of the port placed into the stomach through a small anterior gastrotomy. The band was cut in the stomach and removed. The anterior gastrotomy was closed. We had a perfect intragastric view of the gastric banding. Results. There were no intra- or postoperative complications. The patient was discharged on the fifth postoperative day on a gastric adapted diet. Conclusion. Removal of a gastric band after gastric erosion by SILS is feasible, safe, and effective. This is the first reported case of transgastric removal of eroded bands using an SILS device.
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Wang X, Zheng CZ, Chang XS, Zhao X, Yin K. Laparoscopic adjustable gastric banding: a report of 228 cases. Gastroenterol Rep (Oxf) 2013; 1:144-8. [PMID: 24759820 PMCID: PMC3938002 DOI: 10.1093/gastro/got023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding (LAGB) in obese patients. Methods: This retrospective study included 228 patients (73 males and 155 females, mean age, 32.5 ± 10.3 years) who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011. The body weight and postoperative complications were followed up. Results: The pre-operative mean body mass index (BMI) was 39.5 ± 6.3 kg/m2. Except in one case of inadequate exposure of the stomach, all laparoscopic procedures were successfully accomplished, with no conversion to open surgery. The mean operation time was 65.0 ± 20.3 min. The mean hospital stay was 2.7 ± 0.9 days. Early postoperative complications (<30 days) occurred in five cases (2.2%) and late complications (>30 days) occurred in 75 cases (32.9%), including 56 cases (24.6%) with band-associated complications. The percentage of excess weight loss (EWL%) at 1, 3 and 5 years was 40.5 ± 30.5%, 59.5 ± 41.5% and 58.9 ± 46.4%, respectively. The percentages of patients with EWL% >25%, >50% and >75% were, respectively, 60%, 33% and 0% at 1 year follow-up, 43%, 39%, and 16% at 3 years follow-up and 40%, 34% and 16% at 5 years follow-up. Conclusion Although LAGB has low peri-operative mortality and morbidity rates, it is associated with a high late complication rate and unsatisfactory weight loss. It may be optional, but not the first choice, for the treatment of obesity.
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Affiliation(s)
| | | | | | | | - Kai Yin
- *Corresponding author. Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China. Tel: +02131161586; E-mail:
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Rodarte-Shade M, Barrera GT, Arredondo JFH, Diaz RR. Hybrid technique for removal of eroded adjustable gastric band. JSLS 2013; 17:338-41. [PMID: 23925033 PMCID: PMC3771806 DOI: 10.4293/108680813x13654754534279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A hybrid technique of laparoscopy and endoscopy can be successful in removal of eroded gastric bands. Background: Intragastric migration is a late and rare postsurgical complication in patients with gastric band placement. Gastric band erosion rate has previously been described to be 1.46%. In this report, we present the case of a 43-y-old male with gastric band erosion undergoing a laparoendoscopic retrieval of the gastric band, due to intragastric migration. Method: A hybrid procedure was performed to retrieve the gastric band. A laparoscopic approach was initially used to extract the connecting tube. Endoscopy was then performed to cut the gastric band with a specific cutter system and was subsequently extracted transorally. Results: The postoperative course was uneventful. Clear liquids were started on day 1, and the patient was discharged on day 2. Discussion: The purpose of this study was to describe a hybrid technique for the removal of an eroded gastric band, as a safe and feasible option in patients with band erosions. Conclusion: The laparoscopic approach enables safe extraction of the connecting tube, while endoscopy allows extraction of the band without creating a large incision in the stomach.
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Affiliation(s)
- Mario Rodarte-Shade
- Department of Surgery, Instituto Tecnologico y de Estudios Superiores de Monterrey, Mexico.
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Kim JH, Jung SH, Kim YJ, Park SL, Kim DH. Long-term fecal diverting device for the prevention of sepsis in case of colorectal anastomotic leakage: an animal experiment. Int J Colorectal Dis 2013; 28:477-84. [PMID: 23053676 PMCID: PMC3639361 DOI: 10.1007/s00384-012-1580-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new fecal diverting device (FDD) was fabricated for fecal diversion from the proximal colon above the anastomosis to outside the anus for protecting the rectal anastomosis. The aim of the study is to evaluate the safety and effectiveness of the FDD. METHODS After a pilot study, a prospective observational trial was performed in 34 mongrel dogs. The experiment comprised of segmental resection and anastomosis of the colon, fixation of the FDD, and observation for 3 weeks (n = 15) and more than 3 weeks (n = 19) without initiation of parenteral nutrition. RESULTS Four cases of perioperative death unrelated to the FDD were excluded. Twenty-six (87 %) of the 30 dogs survived. Sixteen (53 %) dogs were able to retain the FDD for more than 3 weeks until 82 days. The autopsy findings revealed that four (15 %) dogs showed colonic wall erosions and mucosal scarring respectively at the band fixation area without evidence of serious septic complications. The surviving dogs retained the FDD for more than 6 days. Mortality occurred in four of the five dogs that expelled the FDD within three postoperative days. A closed abscess cavity as the evidence of anastomotic leakage was noted in seven (23 %) of the surviving dogs. CONCLUSIONS The newly designed fecal diverting device can be retained for more than 3 weeks until 82 days without any serious complications. The FDD may prevent sepsis in case of anastomotic leakage if it is retained for more than 6 days.
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Affiliation(s)
- Jae Hwang Kim
- Department of Surgery, School of Medicine, Yeungnam University, Daegu, Korea.
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Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients. Surg Endosc 2012; 27:1151-7. [DOI: 10.1007/s00464-012-2566-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/23/2012] [Indexed: 11/26/2022]
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Pfeiffer JD, Grant J, Lutfi RE. Transanal protrusion of gastric band tubing: a rare complication of laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 9:e23-4. [PMID: 22959471 DOI: 10.1016/j.soard.2012.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua D Pfeiffer
- University of Illinois at Chicago, Metropolitan Group Hospitals, Chicago, Illinois 60657, USA.
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Stefater MA, Wilson-Pérez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev 2012; 33:595-622. [PMID: 22550271 PMCID: PMC3410227 DOI: 10.1210/er.2011-1044] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite considerable scientific progress on the biological systems that regulate energy balance, we have made precious little headway in providing new treatments to curb the obesity epidemic. Diet and exercise are the most popular treatment options for obesity, but rarely are they sufficient to produce long-term weight loss. Bariatric surgery, on the other hand, results in dramatic, sustained weight loss and for this reason has gained increasing popularity as a treatment modality for obesity. At least some surgical approaches also reduce obesity-related comorbidities including type 2 diabetes and hyperlipidemia. This success puts a premium on understanding how these surgeries exert their effects. This review focuses on the growing human and animal model literature addressing the underlying mechanisms. We compare three common procedures: Roux-en-Y Gastric Bypass (RYGB), vertical sleeve gastrectomy (VSG), and adjustable gastric banding (AGB). Although many would group together VSG and AGB as restrictive procedures of the stomach, VSG is more like RYGB than AGB in its effects on a host of endpoints including intake, food choice, glucose regulation, lipids and gut hormone secretion. Our strong belief is that to advance our understanding of these procedures, it is necessary to group bariatric procedures not on the basis of surgical similarity but rather on how they affect key physiological variables. This will allow for greater mechanistic insight into how bariatric surgery works, making it possible to help patients better choose the best possible procedure and to develop new therapeutic strategies that can help a larger portion of the obese population.
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Affiliation(s)
- Margaret A Stefater
- Metabolic Diseases Institute, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA
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