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Pujol-Rafols J, Uyanik O, Curbelo-Peña Y, Abbas AA, Devriendt S, Guerra A, Herrera MF, Himpens J, Pardina E, Pouwels S, Ramos A, Ribeiro RJ, Safadi B, Sanchez-Aguilar H, De Vries CEE, Van Wagensveld B. Adjustable Gastric Banding Conversion to One Anastomosis Gastric Bypass: Data Analysis of a Multicenter Database. J Gastrointest Surg 2022; 26:1147-1153. [PMID: 35230640 DOI: 10.1007/s11605-022-05277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/11/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has been proposed as a rescue technique for laparoscopic adjustable gastric banding (LAGB) poor responders. AIM We sought to analyze, complications, mortality, and medium-term weight loss results after LAGB conversion to OAGB. METHODS Data analysis of an international multicenter database. RESULTS One hundred eighty-nine LAGB-to-OAGB operations were retrospectively analyzed. Eighty-seven (46.0%) were converted in one stage. Patients operated on in two stages had a higher preoperative body mass index (BMI) (37.9 vs. 41.3 kg/m2, p = 0.0007) and were more likely to have encountered technical complications, such as slippage or erosions (36% vs. 78%, p < 0.0001). Postoperative complications occurred in 4.8% of the patients (4.6% and 4.9% in the one-stage and the two-stage group, respectively). Leak rate, bleeding episodes, and mortality were 2.6%, 0.5%, and 0.5%, respectively. The final BMI was 30.2 at a mean follow-up of 31.4 months. Follow-up at 1, 3, and 5 years was 100%, 88%, and 70%, respectively. CONCLUSION Conversion from LAGB to OAGB is safe and effective. The one-stage approach appears to be the preferred option in non-complicate cases, while the two-step approach is mostly done for more complicated cases.
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Affiliation(s)
| | - Ozlem Uyanik
- Consorci Sanitari Alt Penedès I Garraf, Barcelona, Spain
| | | | - Amr Al Abbas
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | | | | | - Miguel F Herrera
- Instituto Nacional de Nutrición. Centro Médico ABC, México City, México
| | | | - Eva Pardina
- Departament de Bioquímica I Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Almino Ramos
- Gastro-Obeso-Center - Advanced Institute In Bariatric And Metabolic Surgery, Sao Paulo, Brazil
| | - Rui J Ribeiro
- Centro Multidisciplinar da Doença Metabólica Grupo Lusiadas Saúde, Hospital Lusíadas Amadora, Lisboa, Portugal
| | - Bassem Safadi
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Analysis of a Multicenter Database Concerning 832 Patients. Obes Surg 2020; 30:5026-5032. [PMID: 32880049 DOI: 10.1007/s11695-020-04951-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is often the preferred conversion procedure for laparoscopic adjustable gastric banding (LAGB) poor responders. However, there is controversy whether it is better to convert in one or two stages. This study aims to compare the outcomes of one and two-stage conversions of LAGB to RYGB. METHODS Retrospective review of a multicenter prospectively collected database. Data on conversion in one and two stages was compared. RESULTS Eight hundred thirty-two patients underwent LAGB conversion to RYGB in seven specialized bariatric centers. Six hundred seventy-three (81%) were converted in one-stage. Patients in the two-stage group were more likely to have experienced technical complications, such as slippage or erosions (86% vs. 37%, p = 0.0001) and to have had a higher body mass index (BMI) (41.6 vs. 39.9 Kg/m2, p = 0.005). There were no differences in postoperative complications and mortality rates between the one-stage and two-stage groups (13.5% vs. 10.8%, and 0.7% vs. 0.0% respectively, p = ns). Mean final BMI and %total weight loss (%TWL) for the one-stage and the two-stage groups were 31.6 vs. 32.4 Kg/m2 (p = ns) and 30.4 vs. 26.8 (p = 0.017) after a mean follow-up of 33 months. Follow-up at 1, 3, and 5 years was 98%, 75%, and 54%, respectively. CONCLUSIONS One-stage conversion of LAGB to RYGB is safe and effective. Two-stage conversion carries low morbidity and mortality in the case of band slippage, erosion, or higher BMI patients. These findings suggest the importance of patient selection when choosing the appropriate conversion approach.
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Nor Hanipah Z, Punchai S, Antoine HJ, Brethauer SA, Schauer PR, Aminian A. Removal of Gastric Band Does Not Always Lead to Significant Weight Gain. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2018.0010] [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)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Suriya Punchai
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Heath J. Antoine
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stacy A. Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Schäfer A, Gehwolf P, Umlauft J, Dziodzio T, Biebl M, Perathoner A, Cakar-Beck F, Wykypiel H. Revisional Gastric Bypass After Failed Adjustable Gastric Banding-One-Stage or Two-Stage Procedure? Obes Surg 2020; 29:943-948. [PMID: 30484173 DOI: 10.1007/s11695-018-3614-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB) is the preferred procedure after failed adjustable gastric banding. Little is known about whether a one-stage procedure (one surgery for band removal and R-LRYGB) or a two-stage procedure (first band removal and later R-LRYGB) is superior. Aim of this study is to compare early- and long-term results of both methods at our institution. METHODS Retrospective analysis of 165 (m 26/f 139) consecutive patients (98 one-stage, 67 two-stage) with R-LRYGB. Mean follow-up time was 50.1 ± 38.8 months. Indications for one-stage vs. two-stage procedures, operating time, peri- and postoperative complications, morbidity, mortality, and length of stay (LOS) were analyzed. Data are reported as total numbers (%) and mean ± standard deviation. RESULTS Mean age at R-LRYGB was 43.9 ± 10.7 vs. 44.3 ± 10.7 years with a BMI of 37.1 ± 6.8 vs. 39.8 ± 7.1 (one-stage vs. two-stage). In the one-stage group, the main indication for revisional surgery was weight regain (57.1%), followed by dilatation of the esophagus or pouch (37.7%) and gastroesophageal reflux disease (GERD) (36.7%), whereas in the two-stage group, it was band erosion (52.2%) and dilatation of the esophagus or pouch (17.9%) and GERD (11.9%). There was no significant difference in operative time (208.5 ± 61.2 vs. 206.3 ± 73.5 min), LOS (8.6 ± 3.4 vs. 9.3 ± 5.7 days) or mortality (0% overall). Major complications (Clavien-Dindo ≥ IIIa) occurred similarly often in both groups: 15.3% vs. 16.9% (one-stage vs. two-stage). CONCLUSION Both approaches achieve good results. However, the one-stage R-LRYGB is the preferable procedure because it reduces costs and LOS by doing without an additional surgical procedure.
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Affiliation(s)
- A Schäfer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Philipp Gehwolf
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - J Umlauft
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - T Dziodzio
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - M Biebl
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - A Perathoner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - F Cakar-Beck
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Wykypiel
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Abstract
OBJECTIVE The aim of this paper is to report, with a high follow-up rate, 10-year results in a large cohort of patients after Roux-en-Y gastric bypass (RYGBP) done essentially by laparoscopy. BACKGROUND RYGBP has been performed for 50 years, including 20 years by laparoscopy, yet very few long-term results have been reported, mostly after open surgery. METHODS Prospective bariatric database established since the introduction of bariatric surgery. Retrospective data analysis on weight loss, long-term complications, quality of life, and comorbidities. RESULTS In all, 658 consecutive patients (515 women/143 men) were included: 554 with primary RYGBP, 104 with reoperative RYGBP. There was 1 (0.15%) postoperative death. Thirty-two (5%) patients died during follow-up from causes unrelated to surgery. Ten years after primary RYGBP, patients lost 28.6 ± 10.5% of their initial weight, corresponding to a mean of 13.2 body mass index (BMI) units. Among them, 72.8% achieved a BMI <35. Weight loss ≥20% was seen in 80.3% and <10% in 3.9% of patients. Results were similar in patients undergoing primary or reoperative RYGBP, but were better in patients who were initially less obese (BMI <50 kg/m) than in superobese patients. Quality of life and comorbidities significantly improved with 80% resolution or improvement of metabolic comorbidities. All patients required supplementations, and 14.6% required long-term reoperation. CONCLUSIONS RYGBP provides long-term satisfactory weight loss up to 10 years, and significantly improves quality of life and comorbidities. Long-term complications requiring reoperation can develop. Mineral and vitamin supplementation are universally necessary. Other more effective surgical options should be discussed in patients with very severe obesity.
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Pinto-Bastos A, Conceição E, de Lourdes M, Arrojado F, Brandão I, Machado PPP. Psychological and Behavioral Aspects of Primary and Reoperative Surgery: a 6-Month Longitudinal Study. Obes Surg 2018; 28:3984-3991. [PMID: 30105661 DOI: 10.1007/s11695-018-3452-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6 months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group). METHODS This longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6 months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency. RESULTS Preoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6 months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219) = 5.84, p = 0.016), shape (F(1,219) = 5.59, p = 0.019), weight concerns (F(1,219) = 13.36, p = 0.000), depression (F(1,219) = 7.17, p = 0.008), anxiety (F(1,219) = 6.94, p = - 0.009), and compulsive grazing (F(1,219) = 6.13, p = 0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (χ2 = 0.70, p = 0.872). In the R-Group, post-surgery anxiety (Waldχ2(1) = 6.19, p = 0.01) and the post-surgery number of days with grazing in the previous month (Waldχ2(1) = 3.90, p = 0.04) were significant predictors of weight loss. CONCLUSION At 6 months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.
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Affiliation(s)
- Ana Pinto-Bastos
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Eva Conceição
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal.
| | - Marta de Lourdes
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Filipa Arrojado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Isabel Brandão
- Faculty of Medicine, University of Porto, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo P P Machado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
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Pujol Rafols J, Al Abbas AI, Devriendt S, Guerra A, Herrera MF, Himpens J, Pardina E, Peinado-Onsurbe J, Ramos A, Ribeiro RJDS, Safadi B, Sanchez-Aguilar H, de Vries C, Van Wagensveld B. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis 2018; 14:1659-1666. [PMID: 30236443 DOI: 10.1016/j.soard.2018.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To date, laparoscopic adjustable gastric banding remains the third most commonly performed surgical procedure for weight loss. Some patients fail to get acceptable outcomes and undergo revisional surgery at rates ranging from 7% to 60%. Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and sleeve gastrectomy (SG) are among the most common salvage options for failed laparoscopic adjustable gastric banding. OBJECTIVE To compare the outcomes of converting failed laparoscopic adjustable gastric banding to RYGB, OAGB, or SG. METHODS Data collected from 7 experienced bariatric centers around the world were retrospectively collected, reviewed, and analyzed. Final body mass index (BMI), change in BMI, percentage excess BMI loss, and major complications with particular attention to leaks, hemorrhage, and mortality were reported. RESULTS Of 1219 patients analyzed, 74% underwent RYGB, 16% underwent OAGB, and 10% underwent SG after banding failure. The mean age was 38 years (±10 yr), and 82% of patients were women. The mean follow-up was 33 months. The follow-up rate was 100%, 87%, and 52% at 1, 3, and 5 years, respectively. At the latest follow-up, percentage excess BMI loss >50% was achieved by 75% of RYGB, 85% of OAGB, and 67% of SG patients. Postoperative complications occurred in 13% of patients after RYGB, 5% after OAGB, and 15% after SG. CONCLUSION Our data show that it is possible to achieve or maintain significant weight loss with an acceptable complication rate with all 3 surgical options.
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Affiliation(s)
| | - Amr I Al Abbas
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Stefanie Devriendt
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | | | - Miguel F Herrera
- Instituto Nacional de Nutrición. Centro Médico ABC, México City, México
| | - Jacques Himpens
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | - Eva Pardina
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Almino Ramos
- GastroObeso-Center - Advanced Institute In Bariatric And Metabolic Surgery, Sao Paulo, Brazil
| | | | - Bassem Safadi
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Creange C, Jenkins M, Pergamo M, Fielding G, Ren-Fielding C, Schwack B. Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes. Surg Obes Relat Dis 2018; 14:1531-1536. [PMID: 30449510 DOI: 10.1016/j.soard.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss. OBJECTIVE To compare the weight loss results of these 2 surgeries. SETTING University hospital, United States. METHODS A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations. RESULTS The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087). CONCLUSION Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.
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Affiliation(s)
- Collin Creange
- Department of General Surgery, NYU Langone Medical Center, New York, New York.
| | - Megan Jenkins
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - Matthew Pergamo
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - George Fielding
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | | | - Bradley Schwack
- Department of General Surgery, NYU Langone Medical Center, New York, New York
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Giet L, Baker J, Favretti F, Segato G, Super P, Singhal R, Ashton D. Medium and long-term results of gastric banding: outcomes from a large private clinic in UK. BMC OBESITY 2018; 5:12. [PMID: 29686879 PMCID: PMC5897937 DOI: 10.1186/s40608-018-0189-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/29/2018] [Indexed: 01/06/2023]
Abstract
Background Laparoscopic adjustable gastric band (LAGB) has been an established bariatric procedure for the last three decades and was, for many years, the first-choice procedure for the treatment of chronic obesity. However, more recently, the popularity of the LAGB has been in sharp decline and has been replaced by other procedures such as the Roux-En-Y gastric bypass and sleeve gastrectomy. A key driver in this decline has been the high revision and early explanation rates reported in some studies. Methods This was a retrospective study of 2246 patients who underwent LAGB at a large private clinic in the UK between June 2004 and October 2014. Results 2246 patients were included in the study; 1945 (84.6%) were women. All patients were followed up for 2 years following their procedure and subsequent follow up was at the discretion of patients. Mean follow up duration was 43.7 +/− 29.3 months. Operative mortality was zero and there were no in-hospital returns to theatre. Mean preoperative weight and body mass index (BMI) were 111.2 ± 22.1 kg and 39.9 ± 6.7 kg/m2 respectively. Mean excess % BMI loss at 1-, 2-, 5- and 8-years of follow-up was 43.1 ± 25.4, 47.9 ± 31.9, 52.4 ± 41.7 and 57.1% ± 28.6 respectively. There was no significant difference in mean excess % BMI loss between those < 50 or ≥ 50 years old (p value = 0.23) or between patients with an initial BMI of < or ≥ 50 kg/m2 (p value = 0.65). Complications over nine years occurred in 130 (5.8%) patients and included: 39 (1.7%) slippage or pouch dilatation, 2 (0.04%) erosions and 76 (3.4%) problems related to the access port or LAGB tubing. The overall re-operation rate for LAGB complications was 4.2% over 9 years with a LAGB explantation rate of 1.5%. 39 LAGBs were converted to a sleeve or gastric bypass procedure, 11 of these due to complications. Conclusion This is the first study to report on LAGB outcomes from a private clinic in the UK. LAGB is a safe procedure, which delivers significant and durable weight loss with acceptable complications rates and low re-operation rate.
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Affiliation(s)
- Leeying Giet
- 1Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julia Baker
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Franco Favretti
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Gianni Segato
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Paul Super
- 1Heart of England NHS Foundation Trust, Birmingham, UK.,Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Rishi Singhal
- 1Heart of England NHS Foundation Trust, Birmingham, UK.,Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
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Lee AN, Johnson R, Lakhani I, Happe LE. Outcomes at Bariatric Surgery Centers of Excellence and Non-Designated Centers: A Retrospective Cohort Study in a TRICARE Population. Am Surg 2018. [DOI: 10.1177/000313481808400326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In 2013, the Centers for Medicare and Medicaid Services reversed their coverage policy that limited bariatric operations to Centers of Excellence (COE). Data from Centers for Medicare and Medicaid Services may not be generalizable to younger, healthier populations; additional data are needed to inform coverage policies for other plans. This retrospective cohort study used the 2010 to 2011 administrative claims data from the TRICARE military healthcare program to evaluate readmission rates, readmission length of stay, and postoperative healthcare costs among patients who had bariatric surgery at a COE versus non-designated centers. Outcomes were reported at 30, 60, and 90 days, and compared using logistic and linear regression models while controlling for age, gender, and military status. A total of 3027 patients underwent bariatric operations (mean age 44.16, 84.11% female). At 30 days, there were no significant differences between patients in COEs (n = 2413) and non-designated centers (n = 614), in readmission rates (4.77%, 4.40%, P = 0.70), mean length of stay (5.5 days, 6.7 days, P = 0.41), or mean postoperative healthcare costs ($754, $962, P = 0.398). There were no significant differences in any outcomes at 60 or 90 days. Combined with concerns related to COE patient access barriers, these findings strengthen the evidence that reject the requirement for bariatric surgeries to be performed at COEs.
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Affiliation(s)
- Ashley N. Lee
- University of Louisville School of Medicine, Louisville, Kentucky
| | | | - Indu Lakhani
- Humana Government Business, Louisville, Kentucky
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Kuzminov A, Palmer AJ, Wilkinson S, Khatsiev B, Venn AJ. Re-operations after Secondary Bariatric Surgery: a Systematic Review. Obes Surg 2017; 26:2237-2247. [PMID: 27272668 DOI: 10.1007/s11695-016-2252-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper reviews reoperations rates for short- and long-term complications following secondary bariatric procedures and need for further bariatric surgery. The search revealed 28 papers (1317 secondary cases) following at least 75 % of patients for 12 months or more. For adjustable gastric banding (AGB), rebanding had higher re-revisional rates than conversions into other procedures. Conversion of AGB to Roux-en-Y gastric bypass had the highest number of short- (10.7 %) and long-term (22.0 %) complications. We estimated 194 additional reoperations per 1000 patients having a secondary procedure, 8.8 % needing tertiary surgery. Despite being poorly reported, risks of reoperations for long-term complications and tertiary bariatric surgery are higher than usually reported risks of short-term complications and should be taken into account when choosing a secondary bariatric procedure and for economic evaluations.
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Affiliation(s)
- Alexandr Kuzminov
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | | | | | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia.
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12
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Patel RV, Woodburn P, Skipworth JRA, Smellie WJB. Management of Slipped Gastric Bands via Creation of a De Novo Tunnel and Band Replacement: a Single-Centre Experience. Obes Surg 2017; 28:1377-1384. [PMID: 29236206 DOI: 10.1007/s11695-017-3032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A lack of clarity remains over the optimal strategy for the management of laparoscopic adjustable gastric band (LAGB) slippage, which, although rare (around 3% in our experience), can when acute result in obstruction, gastric erosion or ischaemia. Typically, slipped bands are removed acutely. The aim of this study was to explore outcomes following immediate or delayed resiting of slipped LAGBs in a single centre, comparing simple repositioning with retunnelling and replacement. METHODS A retrospective analysis of computerised records, notes and prospectively maintained bariatric databases was undertaken to identify all patients with a slipped LAGB in a single centre. RESULTS Thirty-two patients required operative intervention following a diagnosis of slipped LAGB (median time from initial LAGB insertion to slippage 2.9 years). Two (6%) patients underwent band removal and 30 (94%), band revision surgery (25 immediately and five at a planned but expedited procedure).Twenty-four (77%) patients underwent insertion of a new LAGB via a de novo retrogastric tunnel, five (21%) of which required further future operative intervention; whereas, six (23%) patients underwent repositioning of the existing LAGB within the same tunnel, five (83%) of which underwent further operative intervention (log-rank test p = 0.0001). Following LAGB revision, there was no significant further change in BMI (median + 1 kg/m2; range - 13 to + 10 kg/m2). CONCLUSION Resiting of slipped LAGBs is safe and maintains weight loss. Although a significant risk of future operative intervention remains, this can be reduced via the creation of a de novo retrogastric tunnel for band resiting.
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Affiliation(s)
- Roshani Vijaykumar Patel
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Patrick Woodburn
- Hillingdon Hospitals NHS Trust, Pield Heath Road, Uxbridge, UB8 3NN, UK
| | - James R A Skipworth
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - William James Buchanan Smellie
- Department of Bariatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
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Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass. Obes Surg 2017; 28:1519-1525. [DOI: 10.1007/s11695-017-3047-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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14
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Carandina S, Tabbara M, Galiay L, Polliand C, Azoulay D, Barrat C, Lazzati A. Long-Term Outcomes of the Laparoscopic Adjustable Gastric Banding: Weight Loss and Removal Rate. A Single Center Experience on 301 Patients with a Minimum Follow-Up of 10 years. Obes Surg 2017; 27:889-895. [PMID: 27699566 DOI: 10.1007/s11695-016-2391-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is a chronic disease that requires procedures to enable to maintain good long-term results. Laparoscopic adjustable gastric banding (LAGB) studies with a long-term follow-up are limited and have often given conflicting results. We report our results in terms of banding life span and weight loss in a cohort of 301 patients operated on LAGB with a minimum follow-up of 10 years. METHODS All patients who underwent LAGB at our university hospital between 1998 and 2004 were included in this study. The main outcome was band survival and complications that led to band removal, and the secondary outcome was weight loss. We present raw data and data after imputation for patients lost at follow-up. RESULTS Most patients were women (83 %), and the mean body mass index (BMI) baseline was 45.2 ± 6.7. The pars flaccida technique was performed in 50.9 % of the patients. All patients had at least 10 years of follow-up (range 10-16 years). Data were available at 10 years for 79.7 % and at 15 years for 80.6 %. Band survival was 65.8 % at 10 years and 53.3 % at 15 years. Mean excess weight loss (EWL) at 5, 10, and 15 years was 41.4, 38.7, and 35.1 %, respectively. CONCLUSION Despite the encouraging short-term results, LAGB shows long-term disappointing results in terms of weight loss and complication rates. The removal rate increases with time (about 3-4 % per year), and at 15 years, almost half of the bands had been removed.
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Affiliation(s)
- Sergio Carandina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France.
| | - Malek Tabbara
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Leila Galiay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Claude Polliand
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Daniel Azoulay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of HPB Surgery and Liver Transplant Unit, Henri Mondor University Hospital-Creteil Hospital, Université Paris-Est Creteil Val de Marne, Avenue du Maréchal de Lattre de Tassigny-Avenue de Verdun,, 94000, Creteil, France
| | - Christophe Barrat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", Rue de Stalingrad, Bobigny, France
| | - Andrea Lazzati
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of HPB Surgery and Liver Transplant Unit, Henri Mondor University Hospital-Creteil Hospital, Université Paris-Est Creteil Val de Marne, Avenue du Maréchal de Lattre de Tassigny-Avenue de Verdun,, 94000, Creteil, France
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15
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Ibrahim AM, Thumma JR, Dimick JB. Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery. JAMA Surg 2017; 152:835-842. [PMID: 28514487 DOI: 10.1001/jamasurg.2017.1093] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Following the US Food and Drug Administration approval for laparoscopic gastric band surgery in 2001, as many as 96 000 devices have been placed annually. The reported rates of reoperation range from 4% to 60% in short-term studies; however, to our knowledge, few long-term population-level data on outcomes or expenditures are known. Objective To describe the rate of device-related reoperations occurring after laparoscopic gastric band surgery as well as the associated payments in a longitudinal national cohort. Design, Settings, and Participants This retrospective review of 25 042 Medicare beneficiaries who underwent gastric band placement between 2006 and 2013 identifies gastric band-related reoperations, including device removal, device replacement, or revision to a different bariatric procedure (eg, a gastric bypass or sleeve gastrectomy). The rates of reoperation were risk adjusted using a multivariable logistic regression model that included patient age, sex, race/ethnicity, Elixhauser comorbidities, and the year that the operation was performed. Main Outcomes and Measures Rate of device-related reoperation nationally and across individual hospital referral regions. Thirty-day total episode Medicare payments to hospitals for the index operation and any subsequent reoperations. Results Of the 25 042 patients who underwent gastric band placement, 20 687 (82.61%) were white, 18 143 (72.45%) were women, and the mean age was 57.56 years. Patients (mean age, 57.5; 76.2% women) requiring reoperation had lower rates of hypertension (64.9% vs 73.4%; P < .001) and diabetes (40.4% vs 44.6%; P < .001) and were more likely to have their index operation at a for-profit hospital (34.6% vs 22.0%; P < .001). With an average of 4.5-year follow-up, 4636 patients (18.5%) underwent 17 539 reoperations (an average of 3.8 procedures/patient). Hospital referral regions demonstrated a 2.9-fold variation in risk- and reliability-adjusted rates of reoperation (lower quartile average, 13.3%; upper quartile average, 39.1%). During the study period, Medicare paid $470 million for laparoscopic gastric band associated procedures, of which $224 million (47.6%) of the payments were for reoperations. From 2006 to 2013, the proportion of payments from Medicare for reoperations increased from 16.4% to 77.3% of their annual spending on the gastric band device. Conclusions and Relevance Among Medicare beneficiaries undergoing gastric band surgery, device-related reoperation was common, costly, and varied widely across hospital referral regions. These findings suggest that payers should reconsider their coverage of the gastric band device.
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Affiliation(s)
- Andrew M Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Jyothi R Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.,Surgical Innovation Editor
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16
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Van Looveren R, Mandeville Y, Logghe P, Vandendriessche K, Verbeke X, Vuylsteke P, Pattyn P, Smet B. The Effect of Dumping on Weight Loss in Conversion of Failed Restrictive Surgery: a Cross-Sectional Pilot Study. Obes Surg 2017; 28:665-670. [DOI: 10.1007/s11695-017-2906-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Castagneto Gissey L, Casella Mariolo JR, Mingrone G. How to Choose the Best Metabolic Procedure? Curr Atheroscler Rep 2017; 18:43. [PMID: 27229936 DOI: 10.1007/s11883-016-0590-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bariatric/metabolic surgery has proven to be effective in inducing and maintaining diabetes remission-although with a percentage of patients undergoing hyperglycemia relapse-weight loss, and improvement of the cardiovascular risk. It is, however, associated with mortality, although low, and early and late complications. In particular, metabolic complications are related to vitamin deficiency due to the erratic absorption of the supplemented vitamins and to the unpredictable compliance of patients to vitamin and trace element supplementation. In addition, often, the general practitioners and even the specialists are unaware of the clinical effects of metabolic dysfunction following malabsorptive surgery. The choice of the surgical procedure should be the balance between benefits and risks. Our review addresses this important question trying to give some suggestions.
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Affiliation(s)
- Lidia Castagneto Gissey
- Department of General Surgery, University of Rome "La Sapienza", Rome, Italy. .,James Black Centre, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
| | - James Rossario Casella Mariolo
- Department of General Surgery, University of Rome "La Sapienza", Rome, Italy.,James Black Centre, King's College Hospital, Denmark Hill, SE5 9RS, London, UK
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy.,Department of Diabetes, King's College London, London, UK
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18
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Sharples AJ, Charalampakis V, Daskalakis M, Tahrani AA, Singhal R. Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band. Obes Surg 2017; 27:2522-2536. [DOI: 10.1007/s11695-017-2677-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Abstract
Obesity has become increasingly prevalent, and the number of obese patients in need of liver transplant is expected to continue to increase. In addition, liver disease due to nonalcoholic fatty liver disease is expected to become the leading cause of liver transplantation in the near future. However, obesity remains a relative contraindication in liver transplant. New strategies in managing this patient population are clearly needed. To this end, the authors review the current literature on the efficacy of bariatric surgery in the setting of liver transplantation in obese patients.
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Affiliation(s)
- Duminda Suraweera
- Department of Medicine, Olive-View Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA
| | - Erik Dutson
- Department of Surgery, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA
| | - Sammy Saab
- Department of Surgery, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA; Department of Medicine, University of California at Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA.
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20
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The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 2017; 31:4331-4345. [PMID: 28378086 DOI: 10.1007/s00464-017-5505-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. METHODS An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. RESULTS Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. CONCLUSIONS These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.
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21
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Losh JM, Sanchez B, Waxman K. Refractory pseudoachalasia secondary to laparoscopically placed adjustable gastric band successfully treated with Heller myotomy. Surg Obes Relat Dis 2017; 13:e4-e8. [DOI: 10.1016/j.soard.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
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22
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Arapis K, Tammaro P, Parenti LR, Pelletier A, Chosidow D, Kousouri M, Magnan C, Hansel B, Marmuse J. Long-Term Results After Laparoscopic Adjustable Gastric Banding for Morbid Obesity: 18-Year Follow-Up in a Single University Unit. Obes Surg 2016; 27:630-640. [DOI: 10.1007/s11695-016-2309-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Psychosocial presentation of female bariatric surgery patients after multiple revisional surgeries: A qualitative study. J Health Psychol 2016; 23:1261-1272. [DOI: 10.1177/1359105316648673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Bariatric surgery is currently the most viable and cost-effective treatment for obesity. This study aimed to understand, from a female patient’s perspective, what contributed to not achieving or maintaining excess weight loss from a primary laparoscopic adjustable gastric band surgery, leading to subsequent multiple revisional bariatric surgeries. The purposive sample of participants ( N = 17 females) were over 18 years, had a primary failed laparoscopic adjustable gastric band and had more than three revisional procedures. Participants were individually interviewed and data were analysed from a grounded theory methodology to build a causal model with the core category of unrealistic expectations of bariatric surgery and other important conceptual categories.
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24
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Ereifej LK, Crowell R, Schade D. Rare complication of a common obesity procedure. BMJ Case Rep 2016; 2016:bcr-2015-214121. [PMID: 26921368 DOI: 10.1136/bcr-2015-214121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Laparoscopic gastric banding has been widely used to treat obesity. Aspiration pneumonia has not been reported as a complication of bariatric surgery. We present a patient who had bariatric surgery and presented with aspiration pneumonia. A 64-year-old woman with a medical history of obesity and laparoscopic gastric banding presented to urgent care with 1 month of dry, continuous cough. A chest CT scan demonstrated a large opacity in the left upper lobe peripherally containing an air bronchogram, and the oesophagus was significantly enlarged and fluid filled. The patient was diagnosed with aspiration pneumonia. She received antibiotics and the gastric band was deflated. A repeat CT scan showed resolution of the pneumonia. To our knowledge, aspiration pneumonia is an unreported complication of gastric banding. Not recognising this complication may cause delay in the correct diagnosis and leads to invasive procedures with increased morbidity.
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Affiliation(s)
- Lisa K Ereifej
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard Crowell
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - David Schade
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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25
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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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O’Brien P. Bariatric outcomes and the three-legged stool. Surg Obes Relat Dis 2016; 12:156-7. [DOI: 10.1016/j.soard.2015.10.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/24/2022]
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27
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Lewis KH, Zhang F, Arterburn DE, Ross-Degnan D, Gillman MW, Wharam JF. Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg 2015; 150:787-94. [PMID: 26039097 DOI: 10.1001/jamasurg.2015.1081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: -0.6; 95% CI, -0.9 to -0.4 and -0.4; 95% CI, -0.6 to -0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001). CONCLUSIONS AND RELEVANCE Both laparoscopic AGB and RYGB were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by 3 years postsurgery. On the other hand, RYGB was associated with increased ED visits in the 2 years after surgery. Clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.
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Affiliation(s)
- Kristina H Lewis
- Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta2Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Lewin J, Campbell B, Sanghvi KA, Skinner C, Hopkins G. Laparoscopic adjustable gastric band revisional surgery: a single surgeon series. ANZ J Surg 2015; 87:296-299. [DOI: 10.1111/ans.13359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Joel Lewin
- Department of General Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Beth Campbell
- Department of General Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Kaushal A. Sanghvi
- Department of General Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Department of Upper Gastrointestinal and Bariatric Surgery; Tan Tock Seng Hospital; Singapore
| | - Christine Skinner
- Obesity Surgery Brisbane; Holy Spirit Northside Hospital; Brisbane Queensland Australia
| | - George Hopkins
- Department of General Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Obesity Surgery Brisbane; Holy Spirit Northside Hospital; Brisbane Queensland Australia
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29
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Development of a Measure of Barriers to Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance. Obes Surg 2015; 26:776-84. [DOI: 10.1007/s11695-015-1814-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Echaverry-Navarrete DJ, Maldonado-Vázquez A, Cortes-Romano P, Cabrera-Jardines R, Mondragón-Pinzón EE, Castillo-González FA. [Gastric band erosion: Alternative management]. CIR CIR 2015; 83:418-23. [PMID: 26164136 DOI: 10.1016/j.circir.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 09/04/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world. OBJECTIVE To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible. MATERIAL AND METHODS Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula. CLINICAL CASES The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously. DISCUSSION Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure. CONCLUSIONS Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.
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Affiliation(s)
| | | | - Pablo Cortes-Romano
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
| | - Ricardo Cabrera-Jardines
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
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Shen X, Zhang X, Bi J, Yin K. Long-term complications requiring reoperations after laparoscopic adjustable gastric banding: a systematic review. Surg Obes Relat Dis 2015; 11:956-64. [DOI: 10.1016/j.soard.2014.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 01/27/2023]
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Lanthaler M, Mattesich M, Nehoda H, Puelzl P, Matiasek J, Nitto A, Pierer G, Kinzl J. Long-term Quality-of-life Improvement in Gastric Banding Patients from Body-contouring Surgery. Am Surg 2015. [DOI: 10.1177/000313481508100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Following my prior study of long-term results after laparoscopic gastric banding concerning operative outcome and complications involving the gastric band itself, I now focus on long-term quality-of-life improvement in the same study group after body-contouring surgery. As determined from our electronic patient data system, 72 patients from the former study group subsequently sought body-contouring surgery at our hospital after successful weight loss. Patients were enrolled in a telephone interview and asked about their expectations and body image before and after postbariatric aesthetic surgery and how it altered their well-being in addition to the weight loss achieved with the gastric band. All patients undergoing postbariatric aesthetic surgery felt extremely uneasy with the hanging skin resulting from weight reduction. Patients cannot imagine the degree of dissatisfaction they will experience from the sagging skin that comes with weight loss. Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and reported an extreme improvement in body image. Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery, because most patients not forewarned suffer greatly from their body image after weight loss.
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Affiliation(s)
| | | | - Hermann Nehoda
- St. Johann County Hospital, Department of General Surgery, St. Johann, Tyrol, Austria
| | - Petra Puelzl
- Departments of Plastic and Reconstructive Surgery and
| | | | - Agnese Nitto
- Departments of Plastic and Reconstructive Surgery and
| | | | - Johann Kinzl
- Departments of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; and
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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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Davis JP, LaPar DJ, Schirmer BD, Hallowell PT. Impact of Gastric Prolapse after Laparoscopic Adjustable Gastric Banding for Morbid Obesity. Am Surg 2014. [DOI: 10.1177/000313481408001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gastric prolapse (GP) after laparoscopic adjustable gastric banding (LAGB) remains a complication that has the potential to result in significant morbidities. The purpose of this study was to evaluate the incidence of GP after LAGB and to determine its impact on patient outcomes among the morbidly obese. From 2005 to 2012, 379 consecutive morbidly obese patients underwent LAGB procedures at a single institution. Patients were placed into two groups based on the occurrence of gastric prolapse (GP vs no GP). Patient demographics and risk factors, operative features, and postoperative outcomes were analyzed by univariate analyses to assess the impact of GP. Average patient age was 47 ± 29 years and patients were commonly female (80%) with a median body mass index (BMI) of 44 kg/m2. Incidence of GP was 4.2 per cent (n = 16). LAGB median BMIs at 1 month and 1 year were 41 and 36 kg/m2. There was no difference in 1-year weight loss (BMI GP: 36 kg/m2 vs no GP: 36 kg/m2, P = 0.617). Laparoscopic gastric banding results in significant weight reduction and a low incidence of gastric prolapse. Gastric prolapse has no difference in 1-year postoperative median BMI when compared with patients who did not prolapse.
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Affiliation(s)
- John P. Davis
- From the University of Virginia Health System, Charlottesville, Virginia
| | - Damien J. LaPar
- From the University of Virginia Health System, Charlottesville, Virginia
| | - Bruce D. Schirmer
- From the University of Virginia Health System, Charlottesville, Virginia
| | - Peter T. Hallowell
- From the University of Virginia Health System, Charlottesville, Virginia
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Barrett AM, Vu KT, Sandhu KK, Phillips EH, Cunneen SA, Burch MA. Primary sleeve gastrectomy compared to sleeve gastrectomy as revisional surgery: weight loss and complications at intermediate follow-up. J Gastrointest Surg 2014; 18:1737-43. [PMID: 25118640 DOI: 10.1007/s11605-014-2592-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/08/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The laparoscopic adjustable gastric band (LAGB) can be revised to sleeve gastrectomy (LSG) for various reasons. Data are limited on the safety and efficacy of single-stage removal of LAGB and creation of LSG. METHODS A retrospective review of cases was performed from 2010 to 2013. From the primary LSG group, a control group was matched in a 2:1 ratio. RESULTS Thirty-two patients underwent single-stage revision from LAGB to LSG, with a control group of 64. The most common indication for revision was insufficient weight loss (62.5%). Operative time for revision and control groups was 134 and 92 min, respectively (p < 0.0001). Hospital stay was 3.22 and 2.59 days, respectively (p = 0.02). Overall, the 30-day complication rate for revision and control patients was 14.71 and 6.25%, respectively (p = 0.20). There were no leaks, one stricture (3.13%) in the revision group, and one reoperation for bleeding in the control group (1.56%). For patients with BMI >30 at surgery, change in BMI at 12 months for revision and control was 8.77 and 11.58, respectively (p = 0.02). CONCLUSION Single-stage revision can be performed safely, with minimal increases in hospital stay and 30-day complications. Weight loss is greater in those who undergo primary LSG compared to those who undergo LSG as revision.
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Affiliation(s)
- Allison M Barrett
- Cedars-Sinai Medical Center, 8635 W 3rd St, Ste 770W, Los Angeles, CA, 90048, USA,
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Abstract
This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.
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Affiliation(s)
- David E Arterburn
- Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA
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Abstract
OBJECTIVE To assess the impact of revisional surgery after laparoscopic adjustable gastric banding (LAGB) on weight loss at 12 and 24 months. BACKGROUND There is no uniform consensus as to the optimal procedure for patients requiring revision after LAGB. Few studies address the issue of weight loss after band salvage procedures, despite this being a critical factor in deciding which reoperative procedure to choose. METHODS A retrospective analysis was conducted of adult patients who underwent LAGB from January 1, 2001 to June 30, 2009 at a single institution. Patients who required revision for pouch-related problems including band slippage, pouch dilation, and hiatal hernia were studied. Demographic data, body mass index (BMI), percentage excess weight loss (% EWL), and operative details were recorded. Weights were recorded at 12 and 24 months after revision. These were compared with initial weight, weight before revision, and weight in patients who did not have a reoperation. RESULTS Of 3876 patients, 390 patients were included in analysis of weight outcomes after revision. The procedure-related mortality was 0%. Early (30-day) complications occurred in 0.5%, late complications (erosion) in 0.5%, and 29 patients (7.4%) required a second revision. For patients undergoing revision, the initial weight was 124.06 ± 21.28 kg and BMI was 44.80 ± 6.12 kg/m. At reoperation, weight was 89.18 ± 20.51 kg, BMI was 32.25 ± 6.50 kg/m and, %EWL was 54.13 ± 21.80%. Twelve months postrevision, weight was 92.24 ± 20.22 kg, BMI was 33.32 ± 6.41 kg/m, and %EWL was 48.81 ± 22.71%. Weight was 92.42 ± 19.91 kg, BMI was 33.53 ± 6.25 kg/m, and %EWL was 47.50 ± 22.91% twenty-four months postrevision. CONCLUSIONS Reoperation for pouch-related problems after LAGB is safe and effective. Weight loss is maintained after reoperation.
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Perathoner A, Weißenbacher A, Sucher R, Laimer E, Pratschke J, Mittermair R. Significant weight loss and rapid resolution of diabetes and dyslipidemia during short-term follow-up after laparoscopic sleeve gastrectomy. Obes Surg 2014; 23:1966-72. [PMID: 23868141 DOI: 10.1007/s11695-013-1038-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bariatric surgery has been established as the best option of treatment for morbid obesity. Recently, laparoscopic sleeve gastrectomy (SG) has become very popular because of good postoperative weight loss and low morbidity. The aim of this study was to report our single-center experience with SG regarding feasibility, morbidity, and outcome. METHODS From January 2006 to December 2011, 93 patients (68 female) with a median age of 46 years underwent laparoscopic SG at our department. Thirteen patients had a history of gastric banding with insufficient weight loss or band-related complications. Clinical outcome and laboratory findings were analyzed. RESULTS The mean preoperative and postoperative body mass index (BMI) was 44.1 ± 6.9 and 33.4 ± 6.8 kg/m(2), respectively (p < 0.001). The mean excessive body weight loss after a median follow-up of 11.9 months was 55.7 % ± 24.9 %. Three bleedings, two staple line leakages, and a deep wound infection required conversion to laparotomy (n = 1), reoperation (n = 4), or endoscopic stent implantation (n = 2). Resolution of diabetes and dyslipidemia was seen in 85 and 50 % of patients, respectively. Blood test results of HbA1c, cholesterols, triglycerides, and leptin showed significant postoperative improvement. CONCLUSIONS Laparoscopic SG represents a feasible bariatric procedure with good short-term weight loss, low morbidity rate, and efficient resolution of diabetes and dyslipidemia, especially in patients with lower BMI. The significant decrease of leptin necessitates further studies to understand the ambiguous role of leptin in bariatric surgery.
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Affiliation(s)
- A Perathoner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria,
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Brown WA, Moszkowicz J, Brennan L, Burton PR, Anderson M, O'Brien PE. Pre-operative weight loss does not predict weight loss following laparoscopic adjustable gastric banding. Obes Surg 2014; 23:1611-5. [PMID: 23636997 DOI: 10.1007/s11695-013-0974-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB). METHODS All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points. RESULTS The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years (r = -0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr(2) = 0.34; p = 0.003). CONCLUSIONS Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point.
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Affiliation(s)
- Wendy A Brown
- Centre for Obesity Research and Education, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia,
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O'Brien PE, Brennan L, Laurie C, Brown W. Intensive medical weight loss or laparoscopic adjustable gastric banding in the treatment of mild to moderate obesity: long-term follow-up of a prospective randomised trial. Obes Surg 2014; 23:1345-53. [PMID: 23760764 DOI: 10.1007/s11695-013-0990-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term. The objective of this paper is to determine the long-term (10 years) outcome for patients from a randomised controlled trial (RCT). METHODS A RCT in 2002 compared laparoscopic adjustable gastric band (LAGB) for obesity with non-surgical therapy. Follow-up has been conducted at 10 years. Eighty patients (BMI 30-35) were randomised to a non-surgical or a surgical program. Outcome data are available on 37 (92.5 %) of the surgical patients and 27 (62.5 %) of the non-surgical patients at 10 years. RESULTS Weight change, the metabolic syndrome, quality of life, adverse events and direct costs of the surgical cohort were the main results of the study. A durable weight loss is present in the surgical group with a mean (SD) 10-year weight loss of 14.1 (7.7) kg (63.4 % EWL), better than the non-surgical group (mean (SD) = 0.4 (10.5) kg; p < 0.001). The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups. Proximal gastric enlargements occurred in 17 (30 %) of the 57 who had LAGB and removal of the band occurred in 7 (12 %). The annual maintenance costs including additional surgery was AUD $765 per patient per year. CONCLUSIONS Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy. There is also a sustained reduction of the metabolic syndrome. There is a significant maintenance requirement after LAGB.
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Affiliation(s)
- Paul E O'Brien
- Centre for Obesity Research and Education, Monash University, Melbourne, Australia.
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Walker DM, Hii MW, Skinner CE, Hopkins GH. Roux-en-Y gastric bypass after successful weight loss with a laparoscopic adjustable gastric band: rationales and early outcomes in patients of body mass index<35 kg/m(2.). Surg Obes Relat Dis 2014; 10:1104-8. [PMID: 24986461 DOI: 10.1016/j.soard.2014.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/05/2014] [Accepted: 03/08/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has a number of well-established acute and chronic issues that can require revisional surgical procedures. There is no existing data to evaluate conversion of band patients with body mass index (BMI)<35 kg/m(2) from LAGB to a Roux-en-Y gastric bypass (RYGB). This study aims to report on the indications for and the safety profile of conversion of the LAGB to RYGB in patients with BMI<35 kg/m(2). METHODS A review of data from 200 consecutive conversions of LAGB to RYGB was conducted. Fifty-two patients whose BMI was<35 kg/m(2) were included in this analysis. Indications for conversion, technical details, early morbidity, length of hospital stay, and weight loss data were assessed. RESULTS Laparoscopic conversion to RYGB was performed in 100% of patients. The median BMI pre-RYGB was 32.8 kg/m(2). The most common indication for surgery was weight regain after removal of LAGB (28.8%). There was no mortality. Early morbidity was seen in 25% of patients; the most common complication was stricture of the gastrojejunal anastomosis (9 patients). CONCLUSION Morbidity resulting from conversion of LAGB to RYGB in patients with BMI <35 kg/m(2) is similar to that seen in the BMI>35 kg/m(2) population. The procedure is technically challenging and morbidity rates are higher than those reported for surgically 'naïve' patients. It is recommended that this procedure be undertaken by appropriately trained surgeons in high-volume bariatric centers to optimize safety and outcomes.
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Affiliation(s)
| | - Michael W Hii
- Departments of Upper GI and Obesity Surgery, Eastern Health - Box Hill Hospital, Box Hill, Australia
| | | | - George H Hopkins
- Royal Brisbane and Women's Hospital, Herston, Australia; Holy Spirit Northside Private Hospital, Chermside, Australia
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Cobourn C, Chapman MA, Ali A, Amrhein J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes Surg 2014; 23:903-10. [PMID: 23446665 PMCID: PMC3671103 DOI: 10.1007/s11695-013-0881-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. METHODS Morbidly obese patients, ≥ 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time. RESULTS This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender. CONCLUSIONS Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, 1413 Hurontario St., Mississauga, Ontario, L5G 3H5, Canada.
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44
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Stol A, Dadan DD, Gugelmin G, Ropelato RV. Long follow-up of patients with gastric band. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26 Suppl 1:13-6. [PMID: 24463892 DOI: 10.1590/s0102-67202013000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/26/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The adjustable gastric band laparoscopic technique is safe, reversible and potentially effective alternative to gastric bypass Y-deRoux. However, it has a high rate of reoperation and unsatisfactory weight loss. OBJECTIVE To present a cases series with the use of gastric banding in long term follow-up analyzing the withdrawal rate, its causes and the surgical conversions performed METHODS Retrospective study based on the analysis of 19 patients who underwent the procedure between November 1999 and November 2002, and reviewed with clinical follow-up until late February 2011. The patients were analyzed in the following aspects: gender, age, preoperative weight, preoperative BMI, duration of follow-up, reasons for removal of the gastric band, need for conversion to another type of surgery and failure rate of surgical method. RESULTS Nineteen patients underwent the procedure, four women and 15 men. The mean preoperative BMI was 41.95 kg/m² (36-54). The band was withdrawn in 13 patients (68.42%), including seven by erosion, four for unsatisfactory weight loss and two for gastroesophageal reflux. The gastric bypass was conducted in ten patients and Scopinaro operation in one. Two patients had not been reoperated till nowadays and four were lost in late follow-up. CONCLUSION The gastric band is technically unsatisfactory in long-term evaluation, have high withdrawal rate due to migration or unsatisfactory weight loss.
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da Silva SSP, Maia ÂDC. Patients' experiences after bariatric surgery: a qualitative study at 12-month follow-up. Clin Obes 2013; 3:185-93. [PMID: 25586735 DOI: 10.1111/cob.12032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 06/24/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
This study used a qualitative approach to understand patients' experiences in post-surgery adaptation related to bariatric surgery, 12 months after this procedure. The study population included 30 obese adults, with a mean age of 40.17 years, who were interviewed 12 months after bariatric surgery. Individual interviews, using open-ended questions, were audiotaped, transcribed and coded according to the grounded theory methodology. The data showed that the subjects described themselves as belonging to one of two opposite and separate groups: success or failure. In both groups, two core categories emerged from the data: outcomes and treatment. Previous expectations were reached by the patients who described themselves as successful, with some remaining concerns related to future weight maintenance and aesthetics issues. The failure group emphasized their unmet expectations and the expectancy that surgery would change their lives remained. Treatment in the successful cases integrated lifestyle changes and bariatric surgery, highlighting the personal commitment required to achieve the objectives. The failure group emphasized bariatric surgery without personal commitment, and healthy eating behaviour was understood as a sacrifice. The post-surgical adaptation experiences were diverse: the cases that were described as a success highlighted lifestyle changes, personal efforts and commitment with the global treatment process. External understanding and the desire for a miracle surgery characterized the cases described as a failure. According to these results, it is necessary to promote adequate information about the whole process and skills required to ensure commitment in all treatment dimensions.
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Affiliation(s)
- Susana Sofia Pereira da Silva
- Granted by Foundation for Science and Technology (SFRH/BD/37069/2007), School of Management and Industrial Studies, Vila do Conde, Portugal
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Arterburn D, Maggard MA. Revisiting the 2011 FDA decision on laparoscopic adjustable gastric banding. Obesity (Silver Spring) 2013; 21:2204. [PMID: 23637015 DOI: 10.1002/oby.20476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 02/01/2023]
Affiliation(s)
- David Arterburn
- Group Health Research Institute, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA
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Reibel N. L’existence d’une hyperphagie boulimique influence le choix de la technique opératoire en chirurgie de l’obésité. Eur Psychiatry 2013. [DOI: 10.1016/j.eurpsy.2013.09.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
On distingue trois catégories d’interventions en chirurgie bariatrique les techniques restrictives, comme l’anneau gastrique ajustable (AGA) ou la gastroplastie verticale calibrée (GVC), réduisent la capacité de l’estomac et freinent mécaniquement le passage du bol alimentaire, – les techniques mal absorptives pures, qui sont abandonnées en raison du risque de carences gravissimes,- les techniques mixtes, comme le court circuit gastrique (CCG) ou la gastrectomie en manchon (GM) ; elles associent restriction et mal digestion, provocant des modifications des sécrétions hormonales digestives induisant des effets satiétogène et anorexigène. L’existence d’une hyperphagie boulimique (HB) est un facteur de risque de reprise pondérale quel que soit le type d’intervention [3]. En raison d’une morbi-mortalité post-opératoire immédiate quasi nulle, l’AGA reste très pratiqué en France. les résultats à dix ans retrouvent pour certain un taux d’échec de 50 % [2], lié à des complications, favorisées par l’HB, nécessitant une conversion de technique chirurgicale. Parmi les 196 patients opérés d’une GCV entre 1994 et 2005 à Nancy, 50 % présentaient une HB. Malgré une psychothérapie préopératoire, le taux d’échec à dix ans était de 20 %, dû à la récidive d’HB responsable de complications, nécessitant une réintervention. Parmi les techniques mixtes, le taux d’échec de la GM à cinq ans varie de 15 à 25 %, en partie lié à une dilatation du tube gastrique, favorisée par l’HB, nécessitant une réintervention. Après CCG, en cas de reprise pondérale liée à une récidive de l’HB, dans la majorité des cas, la prise en charge psychothérapeutique permet de retrouver l’efficacité du montage chirurgical sans réopérer, contrairement à la GM ou aux techniques restrictives devenues contre indiquées pour nous en cas d’HB [1]. Le rôle du psychiatre au sein de l’équipe multidisciplinaire de chirurgie bariatrique est essentiel pour le choix de la technique opératoire et maintenir son efficacité au long court.
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Gero D, Dayer-Jankechova A, Worreth M, Giusti V, Suter M. Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®. Obes Surg 2013; 24:114-22. [DOI: 10.1007/s11695-013-1074-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ayloo SM, Masrur MA, Contino G, El Zaeedi M, Giulianotti PC. Two-year follow-up of wound complications associated with laparoendoscopic single-site adjustable gastric banding. Surg Obes Relat Dis 2013; 9:696-700. [DOI: 10.1016/j.soard.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/30/2022]
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Parys S, Werapitiya S. Acutely slipped gastric band with gastric necrosis and massive haemorrhage. J Surg Case Rep 2013; 2013:rjt053. [PMID: 24964464 PMCID: PMC3813746 DOI: 10.1093/jscr/rjt053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We present a case of acute gastric band slippage with gastric necrosis and massive haemoperitoneum necessitating an emergency surgery. The patient presented with an 8h history of dysphagia, vomiting and epigastric pain. Initial examination was unremarkable, but within 6h the patient suddenly deteriorated with a distended peritonitic abdomen. At laparotomy the patient was found to have gastric band slippage, a distended necrotic gastric pouch, a denuded spleen and a massive intraperitoneal haemorrhage of approximately 4l. A splenectomy was performed to control haemorrhage and sleeve gastrectomy to remove the necrotic pouch. The patient made an uneventful recovery. There are no reported cases of massive intraperitoneal haemorrhage or splenic involvement in cases of gastric band slippage. We believe that the gastric necrosis lead to short gastric and splenic vein thrombus and splenic outflow obstruction. This resulted in a subcapsular haematoma which subsequently ruptured causing acute deterioration.
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Affiliation(s)
- Simon Parys
- Department of General Surgery, Bunbury Regional Hospital, Bunbury, Australia
| | - Senarath Werapitiya
- Department of General Surgery, Bunbury Regional Hospital, Bunbury, Australia
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