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Deshmukh A, Desai PM, Ma C, Kushnir V, Eckhouse S, Dimou FM, McCarty TR, Bazarbashi AN. Endoscopic Management of Gastric Band Erosion: a Systematic Review and Meta-Analysis. Obes Surg 2024; 34:494-502. [PMID: 38158502 DOI: 10.1007/s11695-023-06995-4] [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] [Received: 08/30/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gastric band erosion may be seen in up to 3% of patients. Endoscopic intervention has become increasingly utilized due to its minimally invasive nature. The purpose of this study was to perform a systematic review and meta-analysis to examine the role of endoscopic removal for eroded gastric bands. METHODS Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases in accordance with PRISMA and MOOSE guidelines. Outcomes included technical success, clinical success, procedure duration, adverse events, and surgical conversion. Pooled proportions were analyzed using random effects models. Heterogeneity and publication bias was assessed with I2 statistics and funnel plot asymmetry using Egger and Begg tests. Meta-regression was also performed comparing outcomes by endoscopic tools. RESULTS Ten studies (n=282 patients) were included in this meta-analysis. Mean age was 40.68±7.25 years with average duration of band placement of 38.49±19.88 months. Pre-operative BMI was 42.76±1.06 kg/m2 with BMI of 33.06±3.81 kg/m2 at time of band erosion treatment. Endoscopic removal was attempted in 240/282 (85.11%) of cases. Pooled technical and clinical success of the endoscopic therapy was 86.08% (95% CI: 79.42-90.83; I2=28.62%) and 85.34% (95% CI: 88.70-90.62; I2=38.56%), respectively. Mean procedure time for endoscopic removal was 46.47±11.52 min with an intra-operative adverse event rate of 4.15% (95% CI: 1.98-8.51; I2=0.00%). Post-procedure-associated adverse events occurred in 7.24% (CI: 4.46-11.55; I2=0.00%) of patients. Conversion to laparotomy/laparoscopy occurred in 10.54% (95% CI: 6.12-17.54) of cases. CONCLUSION Endoscopic intervention is a highly effective and safe modality for the treatment of gastric band erosion.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, 63104, USA
| | - Parth M Desai
- Division of Gastroenterology and Hepatology, Tower Health, Reading Hospital, Reading, PA, 19611, USA
| | - Christine Ma
- Department of Internal Medicine, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Hepatology and Endoscopy, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Shaina Eckhouse
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Francesca M Dimou
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Thomas R McCarty
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
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Sleiman A, Studer AS, Garneau PY, Denis R, Magdy M, Alanazi M, Pescarus R. Case Report: Endoscopic Removal of an Eroded Gastric Band Causing Small Bowel Obstruction upon Migration into the Proximal Jejunum. Obes Surg 2020; 30:5153-5156. [PMID: 32779076 PMCID: PMC7417257 DOI: 10.1007/s11695-020-04906-5] [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: 06/09/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/03/2022]
Abstract
Background Adjustable gastric banding (AGB) is on the decline due to its relatively modest amount of expected weight loss, coupled with high rates of revision and complications such as band erosion. Management of eroded gastric bands can be challenging especially when complete intra-gastric erosion is followed by distal migration causing small bowel obstruction. Methods We present an endoscopic option of using a pediatric colonoscope to remove an eroded AGB causing jejunal obstruction. Result Endoscopic removal of an eroded ABG causing bowel obstruction was successful. Conclusion Endoscopy remains a safe and relatively non-invasive approach to deal with such complications.
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Affiliation(s)
- Amir Sleiman
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Anne Sophie Studer
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Pierre Y Garneau
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Ronald Denis
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Mark Magdy
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Majed Alanazi
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada
| | - Radu Pescarus
- Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada.
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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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Alawad M, Abukhater M, Al-Mohaimeed K. Eroded adjustable gastric band migration causing gastric obstruction and perforation in a pregnant lady. Int J Surg Case Rep 2020; 71:192-195. [PMID: 32473550 PMCID: PMC7533630 DOI: 10.1016/j.ijscr.2020.04.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022] Open
Abstract
Laparoscopic adjustable gastric banding (LAGB) was considered as one of the most effective management for morbid obesity, with outstanding long-term results on weight loss, comorbidities, and quality of life. Reported complications of LAGB include erosion, infection, migration, obstruction, and rarely ischemia. We report a case of pregnant woman who underwent LAGB 12 years ago diagnosed as gastric obstruction and perforation that was managed by central gastrectomy with gastro-gastrostomy. We encourage the bariatric surgeons to be attentive LAGB complications among women planning for pregnancy.
Background The laparoscopic adjustable gastric band is the least invasive bariatric surgery, which has the advantage of preserving the anatomy of the gastrointestinal tract. In the last two decades, the laparoscopic adjustable gastric band (LAGB) has largely been replaced by other surgical techniques for weight loss because of its high inseparable complications. Although a popular surgical technique at the time of its introduction in 1993, LAGB nowadays reports for not more than 5.5% of all bariatric procedures. The estimated overall long term complication rates of LAGB are ranging from 0.1% to 28%. Objective In this report, we review one of the cases that are considered as an anecdotic event that might follow one of the bariatric procedures. Methods We reported a pregnant lady who undergoes gastric banding 12 years ago. presented with progressively increasing colicky epigastric pain, nausea, and vomiting. The investigations show gastric obstruction and perforation secondary to eroded gastric band and migration. Results The management was completed by the elimination of the gastric band proceed with central gastrectomy plus gastro-gastrostomy with an excellent outcome for the patient and her baby. Conclusion This case highlights an absolutely rare serial complication, that may happen even when the patient presents with a vague complaint. Intraoperative findings can determine the way of management to achieve suitable results. Lastly; we encourage the young Women who underwent or planning for bariatric surgery to do a careful follow-up.
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Affiliation(s)
- Maram Alawad
- Department of Surgery, P.O Box 59046, King Fahad Medical City, Riyadh 11525, Saudi Arabia.
| | - Muhammad Abukhater
- Department of Surgery, P.O Box 59046, King Fahad Medical City, Riyadh 11525, Saudi Arabia.
| | - Khalid Al-Mohaimeed
- Department of Surgery, P.O Box 59046, King Fahad Medical City, Riyadh 11525, Saudi Arabia.
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5
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Furbetta N, Gragnani F, Cervelli R, Guidi F, Furbetta F. Teenagers with obesity: Long-term results of laparoscopic adjustable gastric banding. J Pediatr Surg 2020; 55:732-736. [PMID: 31500873 DOI: 10.1016/j.jpedsurg.2019.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Obesity is a rapidly spreading chronic disease worldwide. Long-term results are critical to assess the effectiveness of a bariatric procedure, particularly in young patients who have long life expectancy. METHODS A retrospective study on adolescents with morbid obesity who underwent Laparoscopic Adjustable Gastric Banding (LAGB) at our institute from 1995 to 2018 was made. Primary endpoints were efficacy, in term of weight loss and comorbidity resolution, occurrence of complications and reoperations. RESULTS Fifty-nine patients underwent LAGB between 1995 and 2018. Intra- and post-operative mortality was absent. The patients' presence at follow-up at 5, 10 and 15 years was 38/50 (76%), 18/25 (72%) and 5/8 (63%), respectively. At those times the mean excess weight loss percentage was 61.7 ± 29.4, 48.1 ± 50.4 and 55.8 ± 51.2, respectively. Comorbidity resolution rates were 100% for patients with diabetes, 78% for patients with hypertension, 75% for joint pain suffers, 69% for patients with sleep apnea and 57% for patients with anxiety and depression. Total reoperation rate was 30.5%. The band was removed in 8 patients: 3 due to erosions, 3 by patients' choice and 2 conversions to other bariatric procedures. CONCLUSION LAGB, in combination with the patients' close follow-up performed by an interdisciplinary team, can be an effective long-term surgical treatment for teenagers with morbid obesity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery, Department of Surgery, University of Pisa, Pisa, Italy.
| | - Francesca Gragnani
- General and Laparoscopic Surgery, Leonardo Clinic, Sovigliana-Vinci (Florence), Italy
| | - Rosa Cervelli
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Francesco Guidi
- General and Laparoscopic Surgery, Leonardo Clinic, Sovigliana-Vinci (Florence), Italy
| | - Francesco Furbetta
- General and Laparoscopic Surgery, Leonardo Clinic, Sovigliana-Vinci (Florence), Italy
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Gosavi R, Balalis G, Packiyanathan A. Mischievous gastric band port: a rare and delayed presentation. J Surg Case Rep 2019; 2019:rjz278. [PMID: 31636889 PMCID: PMC6796177 DOI: 10.1093/jscr/rjz278] [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: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 11/13/2022] Open
Abstract
Bowel perforation is a rare and unusual complication of laparoscopic adjustable gastric band (LAGB) insertion, which if left undiagnosed can have potentially fatal consequences. We present the first case ever published of a delayed presentation of small-bowel perforation secondary to a laparoscopic port insertion. A young woman presented to Emergency Department with intermittent vague abdominal pain for 5 months, on the background of having a LAGB inserted 4 years prior. She was subsequently found to have a small-bowel perforation with mesenteric adhesions to a laparoscopic port site. The patient underwent a successful small-bowel resection with primary anastomosis and made an uneventful recovery.
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Affiliation(s)
- Rathin Gosavi
- Department of Oesophago-Gastric and Bariatric Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - George Balalis
- Department of Oesophago-Gastric and Bariatric Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Packiyanathan
- Department of Oesophago-Gastric and Bariatric Surgery, Alfred Health, Melbourne, Victoria, Australia
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7
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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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8
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Martines G, Picciariello A, Ugenti I, Lagovardou E, Digennaro R, Capuano P. Laparoscopic adjustable gastric banding migration: an early approach for a late complication. G Chir 2019; 38:225-228. [PMID: 29280701 DOI: 10.11138/gchir/2017.38.5.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM Laparoscopic adjustable gastric banding (LAGB) migration is an uncommon late complication after bariatric surgery. It usually presents with an unexplained weight increase or without any symptom. Current guidelines do not establish the timing of a clear endoscopic follow-up to prevent and/or to treat this kind of complication. PATIENTS AND METHODS Long-term follow-up was performed in 217 patients with LAGB (37 underwent surgery in other bariatric centers). At the endoscopic check, 3 patients presented banding erosion respectively 7, 9 and 11 years after surgery. In all three cases the patients, lost at the follow-up in their bariatric centers, had weight gain. During the endoscopy was treated just one patient because of the advanced migration. For the other patients, with a minimal migration, the choice was to perform an endoscopic surveillance every 4 months. DISCUSSION Removal of eroded gastric banding with common endoscopic devices is feasible, safe, and effective. CONCLUSION With our experience we suggest to perform planned endoscopy at least within 2 years in order to guarantee the early diagnosis and managing of gastric banding erosion.
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9
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Furbetta N, Gragnani F, Flauti G, Guidi F, Furbetta F. Laparoscopic adjustable gastric banding on 3566 patients up to 20-year follow-up: Long-term results of a standardized technique. Surg Obes Relat Dis 2018; 15:409-416. [PMID: 30704912 DOI: 10.1016/j.soard.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/17/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND As obesity is a chronic disease, any bariatric procedure should be validated by long-term results. OBJECTIVE To present our long-term results after laparoscopic adjustable gastric banding over a period of >20 years and to investigate the outcomes in terms of efficacy, complications, and reoperations. SETTING Private practice, Italy. METHODS From October 1995 to February 2018, 3566 laparoscopic adjustable gastric banding were performed by a single surgeon. Data were retrieved from a prospectively collected computer database and retrospectively analyzed. Furthermore, patients were stratified according to body mass index and age and results are evaluated for each subgroup. RESULTS All the operations were performed laparoscopically without any mortality and/or major specific complications. Nine hundred twenty-six patients (71.6%) completed at least 10-years follow-up and 180 (58.4%) reached 15-years follow-up. There was a mean of 49%, 52.6%, and 59.2% of excess weight loss at 10, 15, and 20 years, respectively. Major late complications were pouch herniation-dilation (5.8%) and erosion (2.5%), both solved by a replicable, less invasive operation. Total reoperation rate was 24.1%. CONCLUSION Our experience suggested that the combination of a standardized surgical technique and close patient follow-up, performed in collaboration with an interdisciplinary team, may make the laparoscopic adjustable gastric banding system a powerful long-term surgical tool in the treatment of morbid obesity. The best results were obtained in young patients with high body mass index but results were also satisfactory in elderly patients and in those with low body mass index.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery, Department of Surgery, University of Pisa, Pisa, Italy.
| | - Francesca Gragnani
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Giuseppe Flauti
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Guidi
- Anesthesiologist, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Furbetta
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
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Talib A, de Ridder R, Straathof JW, Bouvy ND. Stent-induced compression necrosis for the endoscopic removal of a partially eroded Lap-Band. BMJ Case Rep 2018; 2018:bcr-2018-224670. [PMID: 29898909 DOI: 10.1136/bcr-2018-224670] [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: 11/03/2022] Open
Abstract
Endoscopic removal of eroded Lap-Bands is a minimally invasive alternative to surgical removal that prerequires sufficient erosion through the gastric wall, that is, ≥180° of the gastro-oesophageal wall circumference. A 69-year-old woman presented with dysphagia due to a long-standing Lap-Band erosion, currently of a 60° circumference. Adhesions due to her extensive surgical history rendered surgical treatment undesirable, so a self-expanding stent was placed endoscopically to induce sufficient erosion for subsequent endoscopic removal. During therapy, the patient complained of ructus and dysphagia, probably related to an overly proximally (oesophageal) positioned stent. After a total of 12 weeks, far longer than the described stenting duration in the literature, the Lap-Band was found free in the gastric lumen and was successfully removed using an endoscopic loop. Stent-induced compression necrosis should be considered as a minimally invasive treatment option for Lap-Bands eroded for <180°, with caution in the context of extensive fibrosis.
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Affiliation(s)
- Ali Talib
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rogier de Ridder
- Department of Gastroenterology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Willem Straathof
- Department of Gastroenterology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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11
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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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12
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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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13
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Valli PV, Gubler C. Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery. Clin Obes 2017; 7:115-122. [PMID: 28199050 DOI: 10.1111/cob.12182] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 02/06/2023]
Abstract
The worldwide number of performed bariatric surgeries is increasing continuously, whereas laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are conducted most frequently. Alongside with the usual post-operative and metabolic complications, luminal complications such as anastomotic bleeding, ulceration, leakage, fistula formation, enlargement and stenosis of the anastomosis may occur. Evolution of interventional endoscopy frequently allows endoscopic management of complications, avoiding surgical interventions in most cases. Here, we review the various luminal complications after bariatric surgery with a focus on their endoscopic management.
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Affiliation(s)
- P V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - C Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
- Department of Internal Medicine, Division of Gastroenterology, Kantonsspital Winterthur, Winterthur, Switzerland
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Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc 2017; 9:105-126. [PMID: 28360973 PMCID: PMC5355758 DOI: 10.4253/wjge.v9.i3.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.
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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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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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Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol 2015; 12:701-10. [PMID: 26347162 DOI: 10.1038/nrgastro.2015.151] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.
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Affiliation(s)
- Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Jacques Deviere
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
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Toolabi K, Golzarand M, Farid R. Laparoscopic adjustable gastric banding: efficacy and consequences over a 13-year period. Am J Surg 2015; 212:62-8. [PMID: 26303882 DOI: 10.1016/j.amjsurg.2015.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 05/16/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a common bariatric surgery. Although it is a safe and effective method of weight reduction in short term, it may result in some problems in long term. The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients. METHODS In this prospective study, 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006. Long-term postoperative consequences and complications of these patients were recorded. RESULTS The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2), respectively. Over the 13-year follow-up period, 56 patients (84.8%) experienced at least one complication. The most common complications were band erosion (20 patients) and weight regains (13 patients). Fifty-one patients (78.5%) required reoperation. The band of 48 patients (72.7%) was removed; of these, twenty patients (30.3%) underwent other bariatric surgeries. Percent of excess weight loss was 47.1% ± 30.1%, and the success rate was 48.7%. CONCLUSIONS LAGB is a successful method with low complications in short term; however, over long term, it results in various complications.
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Affiliation(s)
- Karamollah Toolabi
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran 13145-158, Iran.
| | - Mahdieh Golzarand
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Farid
- Department of Social Sciences and Health, Durham University, Durham, UK
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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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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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Complete endoscopic/transgastric retrieval of eroded gastric band: description of a novel technique and review of the literature. Surg Endosc 2013; 27:2974-9. [DOI: 10.1007/s00464-013-2856-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
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Sonavane SK, Menias CO, Kantawala KP, Shanbhogue AK, Prasad SR, Eagon JC, Sandrasegaran K. Laparoscopic Adjustable Gastric Banding: What Radiologists Need to Know. Radiographics 2012; 32:1161-78. [DOI: 10.1148/rg.324115177] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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