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Zhao W, Gao W, Li D, Jin L, Wu X, Liu H, Wang L, Zhao Y, Liu X, Chen P, Dong G. Management of esophagogastric fistula caused by adjustable gastric band erosion: A case report and literature review. Obes Res Clin Pract 2023; 17:428-431. [PMID: 37739856 DOI: 10.1016/j.orcp.2023.09.002] [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: 05/31/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is commonly used in the treatment of morbid obesity. However, with clinical application and long-term follow-up, the shortcomings of this procedure were also exposed, bringing about surgery-related complications include dysphagia, intragastric band migration, slippage, and gastric band erosion. Lower esophageal and gastric fistula is a rare but dangerous complication after LAGB. We describe a case of esophagogastric fistula occurring twelve years after a laparoscopic band procedure and its successful management in a multidisciplinary and staged manner, followed by a short review of the literature.
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Affiliation(s)
- Wen Zhao
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wenxing Gao
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Dingchang Li
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Lujia Jin
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - XianSheng Wu
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Hao Liu
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Wang
- Medical School of Chinese PLA, Beijing, China; Department & Institute of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yingjie Zhao
- Department & Institute of General Surgery, the Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Xianqiang Liu
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Peng Chen
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China.
| | - Guanglong Dong
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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3
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Gara TM, Coleman AB, Roten DP, Rhinewalt JM. Septic Aspiration Pneumonia After Laparoscopic Adjustable Gastric Banding for Morbid Obesity. Cureus 2022; 14:e25074. [PMID: 35719793 PMCID: PMC9202490 DOI: 10.7759/cureus.25074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/21/2022] Open
Abstract
The laparoscopic adjustable gastric banding (LAGB) surgery is a minimally invasive procedure performed to help with weight loss in patients with advanced obesity with a body mass index (BMI) of >40 kg/m² or above 35 kg/m² with comorbid obesity-related health conditions (hypertension, type two diabetes mellitus, obstructive sleep apnea, etc). Although this surgery is effective for weight loss, it is imperative that close follow-up and aftercare are conducted in order to circumvent severe and rare esophageal and pulmonary complications. We report a case of systemic pulmonary and esophageal complications associated with LAGB that required immediate medical and surgical intervention in a female patient. She underwent her surgery in Mexico, and she did not receive any follow-up care for 12 years, which seemingly led to this preventable situation.
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Girardi V, Barone G, Gualtierotti M, De Martini P, Mutignani M, Crippa J, Ferrari G. Laparoscopic Adjustable Gastric Band: Case Report of Erosion with Intragastric Migration Requiring an Extreme Surgical Approach. Obes Surg 2020; 30:2030-2032. [PMID: 32147776 DOI: 10.1007/s11695-020-04455-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- V Girardi
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - G Barone
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - M Gualtierotti
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - P De Martini
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - M Mutignani
- Digestive and Operative Endoscopy Unit, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - J Crippa
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. .,General Surgery Residency Program, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - G Ferrari
- Division of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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Trujillo MR, Muller D, Widmer JD, Warschkow R, Muller MK. Long-Term Follow-Up of Gastric Banding 10 Years and Beyond. Obes Surg 2016. [PMID: 26202418 DOI: 10.1007/s11695-015-1800-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This investigation assessed the long-term outcome of patients with gastric banding implanted more than 10 years ago. METHODS A total of 73 patients undergoing laparoscopic gastric banding between 1997 and 2003 were identified. Patients who had their band removed were converted to a laparoscopic gastric bypass procedure. RESULTS The mean preoperative body mass index (BMI) was 44.4 (SD 5.3). The mean follow-up was 11.6 (SD 2.1) years. The reasons for reoperation were leakage (N = 16, 21.9 %), slipping (N = 15, 20.5 %), and insufficient weight loss (N = 9, 12.3 %). The band was left in situ in 33 patients (45.2 %). The 5- and 10-year survival rates for the banding were 82.2 % (95 %CI 73.9-91.5 %) and 53.4 % (95 %CI 43.1-66.2 %). Best results were observed in male patients (10-year survival rate 76.5 %, 95 %CI 58.7-99.5 %, HR = 0.44, P = 0.043) and patients older than 50 years (10-year survival rate 63.8 %, 95 %CI 51.5-79.2 %, HR = 0.41, P = 0.006). Overall, the BMI was 31.0 (SD 6.3) at follow-up, excess weight loss was 68.1 % (SD 26.4), and the score for the Moorehead-Ardelt Questionnaire was 1.6 (SD 1.0). Similar results were obtained for patients with and without banding failure. CONCLUSION The present investigation provides evidence that gastric banding remains effective after more than 10 years in less than 50 % of initially operated patients. Older (>50 years) and male patients seemed to maintain the banding as long-time carriers with good results, and these patients subjectively profited from this method. Good results can be achieved if patients are followed thoroughly, and alternative surgical options for patients who fail may be offered with longstanding success.
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Affiliation(s)
- Martha R Trujillo
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
| | - Dominik Muller
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
| | - Jeannette D Widmer
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
| | - Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany
| | - Markus K Muller
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland.
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Zampieri N, Castellani R, Francia L. Is There Still a Role for Video-Assisted Laparoscopic Gastric Banding in Severe Obesity? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicola Zampieri
- Department of Surgery, University of Verona, AOUI, Verona, Italy
| | - Roberto Castellani
- Department of Surgery, Casa di Cura San Francesco Hospital, Verona, Italy
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Abstract
Complications of laparoscopic adjustable gastric banding (LAGB) are well documented including migration, erosion, prolapse, infection, pouch dilatation, and gastric perforation. Band prolapse within the first 5 years after LAGB is observed in about 5% of cases, requiring an operative procedure. Here we report our experience of endoscopic treatment of band prolapses. From December 2007 to December 2013, 1,347 consecutive patients (202 male, 1,145 female) underwent LAGB; 47 patients had band prolapses and 7 were treated by endoscopy. All patients were women (median age, 34 years). The mean preoperative body mass index was 38.3 ± 2.9 kg/m2. The mean duration to band prolapse after LAGB was 10.6 ± 5.6 months. The mean duration of endoscopy was 12 ± 3 min. One patient had recurrence of the prolapse 3 months after the first endoscopy and was treated by endoscopy again. There was no operative procedure required and no mortality. Endoscopic treatment of band prolapses is effective without the need for an operative procedure.
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Mathus-Vliegen EMH. The cooperation between endoscopists and surgeons in treating complications of bariatric surgery. Best Pract Res Clin Gastroenterol 2014; 28:703-25. [PMID: 25194185 DOI: 10.1016/j.bpg.2014.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/18/2014] [Accepted: 07/05/2014] [Indexed: 02/09/2023]
Abstract
The results of lifestyle interventions and pharmacotherapy are disappointing in severe obesity which is characterised by premature death and many obesity-associated co-morbidities. Only surgery may achieve significant and durable weight losses associated with increased life expectancy and improvement of co-morbidities. Bariatric surgery involves the gastrointestinal tract and may therefore increase gastrointestinal complaints. Bariatric surgery may also result in complications which in many cases can be solved by endoscopic interventions. This requires a close cooperation between surgeons and endoscopists. This chapter will concentrate on the most commonly performed operations such as the Roux-en-Y gastric bypass, the adjustable gastric banding and the sleeve gastrectomy, in the majority of cases performed by laparoscopy. Operations such as the vertical banded gastroplasty and the biliopancreatic diversion with or without duodenal switch will not be discussed at length as patients with these operations will not be encountered frequently and their management can be found under the headings of the other operations.
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Affiliation(s)
- E M H Mathus-Vliegen
- Academic Medical Centre, University of Amsterdam, Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg 2014; 24:42-55. [PMID: 24081459 DOI: 10.1007/s11695-013-1079-8] [Citation(s) in RCA: 384] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2012, an expert panel composed of presidents of each of the societies, the European Chapter of the International Federation for the Surgery of Obesity (IFSO-EC), and of the European Association for the Study of Obesity (EASO), as well as of the chair of EASO Obesity Management Task Force (EASO OMTF) and other key representatives from IFSO-EC and EASO, devoted the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery in advance of the 2013 European Congress on Obesity held in Liverpool. This meeting was prompted by the extraordinary advancement made in the field of metabolic and bariatric surgery during the past decade. It was agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced by focusing in particular on the evidence gathered in relation to the effects on diabetes and the changes in the recommendations of patient eligibility criteria. The expert panel allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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Affiliation(s)
- M Fried
- Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic,
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10
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Fusco M, James S, Cornell C, Okerson T. Weight loss through adjustable gastric banding and improvement in daytime sleepiness: 2 year interim results of APEX study. Curr Med Res Opin 2014; 30:849-55. [PMID: 24328387 DOI: 10.1185/03007995.2013.874991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Obesity is one factor associated with an increased risk of obstructive sleep apnea (OSA). This study reports the investigator-reported resolution or improvement of OSA and improvements in sleep-related quality of life (QOL) 2 years after surgical placement of the LAP-BAND AP * (LBAP) system. RESEARCH DESIGN AND METHODS The LBAP Experience (APEX) study is an ongoing 5 year, prospective, observational study assessing change in weight, comorbidities, and QOL after LBAP implantation. This is an interim analysis of patients with evaluable data at 24 months who had OSA at baseline. CLINICAL TRIAL REGISTRATION NCT00501085. RESULTS At baseline, 117 of 395 patients (29.6%; mean body mass index [BMI], 45.0 kg/m2) reported OSA; of these, 57 had evaluable patient-reported outcome data at 2 years. Investigator-reported resolution or improvement of OSA was 69% and 86% at post-operative years 1 and 2, respectively. Patients reporting resolution, improvement, or no change in OSA experienced mean changes in BMI and percentage of weight loss of -9.7 kg/m(2)/-21.7%, -8.3 kg/m(2)/-18.7%, and -5.7 kg/m(2)/-13.2%, respectively (n = 54). Mean 2 year BMI was not statistically different between the groups (p = not significant). Mean scores for all Epworth Sleepiness Scale responses for the OSA population improved by -0.43 from baseline (p < 0.0001; n = 78) compared with -0.29 for patients without OSA at baseline (n = 177; p = 0.037 between groups). In addition, the overall study population experienced resolution and/or improvement in other obesity-related comorbidities, such as type 2 diabetes (96%) and hypertension (91%). CONCLUSIONS These data support that surgically facilitated weight loss can improve sleep-related QOL and may result in resolution or improvement of OSA; the degree of weight loss may be related to these changes.
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Affiliation(s)
- Mark Fusco
- Health First Medical Group , Melbourne, FL , USA
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11
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Medical liability in surgery for morbid obesity by adjustable gastric band: Nine case reviews. J Visc Surg 2013; 150:383-8. [DOI: 10.1016/j.jviscsurg.2013.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Burgerhart JS, Aarts EO, van de Meeberg PC, Berends FJ, Siersema PD, Smout AJPM. Esophageal motor responses to increasing adjustment of an implanted gastric band. Neurogastroenterol Motil 2013; 25:587-e461. [PMID: 23534401 DOI: 10.1111/nmo.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The adjustable gastric band is an effective surgical treatment to induce weight loss in patients with morbid obesity. We aimed to assess the effects of band placement and stepwise adjustment on esophageal motility, using high-resolution manometry (HRM). METHODS Patients underwent esophageal HRM before and 6 weeks after gastric band placement. During postoperative assessment, HRM was combined with intraband pressure measurement at increasing filling volumes. KEY RESULTS In total, 15 patients were studied. Mean DCI (±SD) decreased from 1085.3 ± 1064.1 mmHg s(-1) cm(-1) before to 507 ± 347.2 mmHg s(-1) cm(-1) (P = 0.015) after band placement, mean IBP from 10.7 ± 1.7 mmHg to 7.7 ± 1.6 mmHg (P = 0.01). Stepwise band adjustment from 1 to 8 mL had an immediate and profound effect on swallow-induced esophageal contractions: DCI increased from 766 ± 590.4 to 7231 ± 6298.1 mmHg s(-1) cm(-1) , IBP from 4.3 mmHg to 31.1 ± 17.3 mmHg, and intraband pressure increased from -109.1 ± 60.6 mmHg to 150.2 ± 65 mmHg. During band filling with volumes >5 mL, upward displacement of the LES was observed, indicative of shortening of the esophagus; the distance between the UES and LES decreased from 23.5 ± 1.3 cm at 0 mL to 19.9 ± 2 cm at 8 mL. CONCLUSIONS & INFERENCES Stepwise gastric band adjustment leads to immediate enforcement of esophageal peristalsis associated with an increase in intrabolus pressure and with pronounced esophageal shortening. Subjects who lack these responses to outflow obstruction may be more prone to dysphagia after band placement.
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Affiliation(s)
- J S Burgerhart
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. J.S.
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13
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Internal hernia due to adjustable gastric band tubing: review of the literature and illustrative case video. Surg Endosc 2013; 27:4378-82. [PMID: 23771273 DOI: 10.1007/s00464-013-3024-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. Device-related morbidity is typically associated with the subcutaneous port or the band itself. Complications related to band tubing are unusual. Small bowel obstruction (SBO) after LAGB is a unique and serious complication; there is the potential of delayed diagnosis and the risk of closed-loop bowel obstruction. SBO secondary to internal hernia caused by band tubing is very rare, with only five cases reported in the literature. METHODS In this article, we describe our experience and provide an illustrative video of a case of SBO related to band tubing. We also provide a detailed review of the few previously published case reports. RESULTS Based on the common features of our case and other published case reports, we hypothesize some risk factors that might lead to this unique morbidity of adjustable gastric band tubing and provide potential solutions to prevent this problem. CONCLUSION Tubing-related SBO is a serious complication with the risk of closed-loop bowel obstruction. Urgent operative exploration is required to avoid bowel strangulation. To prevent recurrence we advise functionally shortening the tubing by tucking it to the right upper quadrant above the liver and also provide some omental coverage between the bowel and band tubing if possible.
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14
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Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres AJ, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts 2013; 6:449-68. [PMID: 24135948 PMCID: PMC5644681 DOI: 10.1159/000355480] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022] Open
Abstract
In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity-European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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Affiliation(s)
- Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, Istanbul, Turkey
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Jean-Michel Oppert
- Department of Nutrition, Heart and Metabolism Division, Pitie Salpetriere University Hospital (AP-HP) University Pierre et Marie Curie-Paris 6, Institute of Cardiometabolism and Nutrition (ICAN) Paris, France
| | | | - Antonio J. Torres
- Department of Surgery Complutense University of Madrid, Hospital Clinico ‘San Carlos’, Madrid, Spain
| | - Rudolf Weiner
- Sachsenhausen Hospital and Centre for Minimally Invasive Surgery, Johan Wolfgang Goethe University, Frankfurt/M., Germany, Spain
| | - Yuri Yashkov
- Obesity Surgery Service, Centre of Endosurgery and Lithotripsy Moscow, Russia, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBERobn, Instituto de Salud Carlos III, Pamplona, Spain
- *Gema Frühbeck, R Nutr MD PhD, Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBERobn, Instituto de Salud Carlos III, Avda. Pio XII, 36, 31008 Pamplona (Spain),
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Chisholm J, Kitan N, Toouli J, Kow L. Gastric band erosion in 63 cases: endoscopic removal and rebanding evaluated. Obes Surg 2012; 21:1676-81. [PMID: 21710298 DOI: 10.1007/s11695-011-0468-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) remains the most popular bariatric procedure performed in Australia and Europe. Gastric band erosion is a significant complication that results in band removal. The aim of this study is to assess the prevalence of band erosion and its subsequent management with a particular focus on rebanding results. METHODS Patients who underwent LAGB in a prospective cohort study from August 1996 to October 2010 were evaluated. Patients that developed band erosion were identified and clinical presentations, band characteristics and subsequent management were evaluated. RESULTS One thousand eight hundred seventy-four morbidly obese patients underwent LAGB. Band erosion developed in 63 patients (3.4%). Median preoperative BMI was 41.5 kg/m(2) (range 30-61 kg/m(2)). Median time from operation to diagnosis was 39 months (range 6-132 months). Twenty nine patients (46%) were asymptomatic (sudden loss of restriction, weight gain, turbid fluid, or absence of fluid). Symptoms included abdominal pain in 24 (38%), obstruction in 7 (11%), recurrent port infection in 5 (8%), reflux symptoms in 2 (3%) and sepsis in 2 (3%). Fourteen patients (22%) had discolouration of the fluid in their band. Endoscopic removal was attempted in 50 patients with successful removal in 46 (92%). Median number of endoscopies prior to removal was 1.0 (range 1-5). The median duration of the procedure was 46 min (range 17-118 min). Rebanding was performed in 29 patients and 5 (17%) experienced a second erosion. Mean percentage excess weight loss was 54% in the remaining 22 patients with at least 3 months follow-up. CONCLUSIONS Band erosion prevalence was 3.4%. Endoscopic removal of eroded gastric bands was proven safe and effective. Band erosion is now preferably managed endoscopically in our institution. Rebanding following erosion results in acceptable weight loss but an unacceptable reerosion rate.
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Affiliation(s)
- Jacob Chisholm
- Department of General and Digestive Surgery, Flinders Medical Centre and Circle of Care, Bedford Park, Adelaide, SA, 5042, Australia.
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16
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Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surg Endosc 2012; 26:1909-19. [PMID: 22219011 DOI: 10.1007/s00464-011-2125-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/04/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes. METHODS A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%). RESULTS After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5-7 years at approximately 15 kg/m(2) for the LRYGB patients and at about 9 kg/m(2) for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group. CONCLUSIONS Over the long term, LRYGB had an approximate reduction of 15 kg/m(2) BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.
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Medical management of postsurgical complications: the bariatric surgeon's perspective. Gastrointest Endosc Clin N Am 2011; 21:241-56. [PMID: 21569976 DOI: 10.1016/j.giec.2011.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bariatric surgery remains the only effective method to initiate and sustain massive weight loss in morbidly obese patients. Along with the advent of minimal access surgery, its popularity has not only resulted in an exponential increase in number of cases but also a subsequent increase in number of complications. Although most postsurgical bariatric complications are managed surgically, it is imperative that all physicians be aware of the unique potential complications to effectively communicate and optimize the medical management in this emergent set of patients.
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Jacob BP. Comment on: Adjustable gastric banding outcomes with and without gastrogastric imbrication sutures: a randomized controlled trial. Surg Obes Relat Dis 2011; 7:31-2. [PMID: 21255734 DOI: 10.1016/j.soard.2010.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
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19
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Egan RJ, Monkhouse SJW, Meredith HE, Bates SE, Morgan JDT, Norton SA. The Reporting of Gastric Band Slip and Related Complications; A Review of the Literature. Obes Surg 2010; 21:1280-8. [DOI: 10.1007/s11695-010-0344-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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DeNino WF, Zubarik RS, Forgione PM. Laparoscopic gastric band slippage diagnosed with esophagogastroduodenoscopy in a 12-week gestation nulliparous patient. Surg Obes Relat Dis 2010; 7:225-6. [PMID: 20727836 DOI: 10.1016/j.soard.2010.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 01/28/2010] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
Affiliation(s)
- W F DeNino
- Department of Surgery, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, Vermont, USA
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21
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Analysis of poor outcomes after laparoscopic adjustable gastric banding. Surg Endosc 2010; 25:41-7. [PMID: 20589514 DOI: 10.1007/s00464-010-1126-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 05/03/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recent studies document excess weight loss (EWL) of more than 50% with the laparoscopic adjustable gastric band (LGB). This study reviews the LGB experience at an urban academic center in terms of complications, reoperative rates, and comorbidities. METHODS In this study, 144 consecutive patients undergoing LGB were prospectively reviewed. Data were collected including weight, body mass index (BMI), excess weight loss (EWL), comorbidities, and complications. Demographics were analyzed using a t-test. Linear regression was used to analyze the relationship of BMI, race, and age to EWL at 12 months. RESULTS The study participants were 130 women with a mean age of 43 ± 11 years, a mean weight of 127.1 kg ± 20.5 kg, and a mean BMI of 45.6 ± 6.1. The mean follow-up period was 16 months. The mean EWL was 20% ± 14% at 6 months (n = 118), 26% ± 16% at 12 months (n = 106), 30% ± 20% at 18 months (n = 68), and 34% ± 23% at 24 months (n = 43). Patients with a BMI higher than 50 kg/m(2) had a lower EWL at 12 months than patients with a BMI lower than 50 kg/m(2) (P = 0.00005). The mean EWL at 12 months was significantly less for African Americans than for Caucasians (P = 0.0046; 95% confidence interval [CI] 3-15%). Patients older than 50 years had a lower EWL, but the difference was not statistically significant (P = 0.07). Complete and partial resolution of comorbidities occurred for 10% and 4% of the patients, respectively. Removal of the band with revision to a sleeve gastrectomy for inadequate EWL was required for 14 patients (11.5%). Complications occurred for 8% of the patients (n = 15) including port flipping, stoma obstruction, tube disconnection, port infections, dysphagia, and band slippage. Overall, 16.7% of the patients (n = 24) required reoperation. CONCLUSION After LGB, a majority of the patients failed to achieve a 50% EWL, and 16.7% required reoperation. Laparoscopic adjustable gastric banding may not be the optimal bariatric procedure for patients older than 50 years, patients with a BMI higher than 50 kg/m(2), or African Americans.
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Thornton CM, Rozen WM, So D, Kaplan ED, Wilkinson S. Reducing band slippage in laparoscopic adjustable gastric banding: the mesh plication pars flaccida technique. Obes Surg 2010; 19:1702-6. [PMID: 18758868 DOI: 10.1007/s11695-008-9672-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 08/06/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Band slippage is a significant complication of laparoscopic adjustable gastric band (LAGB) surgery for the treatment of morbid obesity. This involves prolapse of part of the stomach, with varying degrees of gastric obstruction. The original perigastric technique (PGT) was associated with slippage rates of up to 25%. The pars flaccida technique (PFT) is the more commonly used technique today, reducing slippage rates to as low as 1.4%. We report a technique not previously described, the modified PFT with the use of mesh, and compare slippage rates between these three techniques for band placement. METHODS A prospectively entered, retrospective review of 1,446 consecutive patients undergoing LAGB by a single surgeon was undertaken. Patients were divided into five consecutive groups: PGT learning curve (PGTLC) (n = 68), PGT (n = 19), mesh PFT (MPFT) (n = 415), mesh plication PFT (MPPFT) (n = 131), and MPPFT with inadequate follow-up (n = 813). Patient characteristics, band slippage, and other complication rates were compared between groups. RESULTS The slippage rates for each group were: PGTLC (10%), PGT (5%), MPFT (0.8%), and MPPFT (0%). This demonstrated a statistically significant difference between the slippage rates for each group (p < 0.001). Combining the MPFT and MPPFT groups, there was a statistically significant difference in band slippage compared to the PGT group (p < 0.001). CONCLUSION While the MPFT is associated with low band slippage rates, the MPPFT results in further reductions in band slippage. The routine use of this modification to the MPFT is safe and may reduce operative morbidity. A randomized comparison of these techniques is warranted.
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DeNino WF, Forgione PM. Small bowel obstruction from small bowel volvulus and gram-positive peritonitis in laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2010; 6:211-2. [PMID: 20096648 DOI: 10.1016/j.soard.2009.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/20/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Walter F DeNino
- Department of Surgery, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT 05401, USA
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25
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26
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Rand JM, Martin JT, Nadzam GS. Video case report: multiple intraperitoneal transections of Lap-Band tubing with descending colon inflammation: cause or effect? Surg Obes Relat Dis 2009; 5:710-2. [PMID: 19945052 DOI: 10.1016/j.soard.2009.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 09/15/2009] [Accepted: 09/15/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Jamie M Rand
- Department of Surgery, Hospital of St. Raphael, New Haven, Connecticut, USA.
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27
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A Serious but Rare Complication of Laparoscopic Adjustable Gastric Banding: Bowel Obstruction Due to Caecal Volvulus. Obes Surg 2009; 19:1197-200. [DOI: 10.1007/s11695-009-9847-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 01/20/2009] [Indexed: 10/20/2022]
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28
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Laparoscopic adjustable gastric band tubing: unusual cause of an internal hernia. Surg Obes Relat Dis 2009; 5:517-8. [PMID: 19356991 DOI: 10.1016/j.soard.2009.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 02/05/2009] [Accepted: 02/07/2009] [Indexed: 11/22/2022]
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Hindle AK, Gonzalez F, Brody F. Anatomical measurements of the gastric cardia in obese patients. Surg Endosc 2009; 23:2522-4. [PMID: 19343427 DOI: 10.1007/s00464-009-0447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 03/12/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, surgeons implant a variety of laparoscopic adjustable gastric bands. However, there is little data to guide the selection process. This study aims to determine the relationship between a patient's body mass index (BMI), height, and weight and the anatomical measurements of the gastric cardia in morbidly obese patients undergoing laparoscopic adjustable gastric band (LAGB) surgery. METHODS A total of 67 morbidly obese patients undergoing LAGB surgery were studied. Intraoperative measurements of the gastric cardia were obtained. The relative circumference and posterior diameter of the gastric cardia were measured along with the patient's height, weight, and BMI. Pearson's correlation coefficient was used to measure the relationship between the circumference and posterior diameter of the gastric cardia and the BMI, height, and weight. A p < 0.05 was considered significant. RESULTS No correlation exists between a patient's BMI or weight and the circumference or diameter of the gastric cardia. A correlation exists between a patient's height and the posterior diameter of the gastric cardia (p = 0.02). Of note, there is a correlation between the relative circumference and the posterior diameter of the gastric cardia for each patient (p = 0.05). CONCLUSION Our unique data show no significant correlation between a patient's BMI and weight and the measurements of the gastric cardia. There was a correlation between a patient's height and the posterior diameter of the gastric cardia. These intraoperative measurements may help surgeons objectively select the appropriate band for each respective patient undergoing LAGB surgery. This may potentially decrease postoperative dysphagia.
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Affiliation(s)
- A Katherine Hindle
- Department of Surgery, The George Washington University Medical Center, Washington, DC 20037, USA
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Abstract
Morbid obesity is a chronic disease of excess fat storage, characterised by premature death and obesity-associated co-morbidities. The results of the current non-surgical treatment to treat obesity are disappointing, but surgical approaches may achieve a durable and longstanding weight loss with resolution and improvement of co-morbidities. Gastrointestinal complaints and digestive complications may, however, increase and may require an actively involved gastroenterologist.
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Affiliation(s)
- E M H Mathus-Vliegen
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Pomerri F, Foletto M, Bernante P, Tonello E, Muzzio PC. Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity. Obes Surg 2008; 19:146-152. [PMID: 18685904 DOI: 10.1007/s11695-008-9632-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. METHODS Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. RESULTS There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. CONCLUSION Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
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Affiliation(s)
- Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. .,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy.
| | - Mirto Foletto
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Paolo Bernante
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Elisa Tonello
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Pier Carlo Muzzio
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy
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Bueter M, Thalheimer A, Wierlemann A, Fein M. Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc 2008; 23:334-40. [PMID: 18443872 DOI: 10.1007/s00464-008-9926-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 03/15/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopic gastric banding (LAGB) is the most popular surgical procedure for morbid obesity in Europe. Long-term complications like slippage of the band or pouch dilatation are well known and lead to reoperations in a substantial number of patients. In this study, results and follow-ups of patients with reoperations after gastric banding were analyzed. METHODS Between May 1997 and June 2006, 172 patients were treated with LAGB for morbid obesity. 41 of these patients underwent one or more band-related reoperations (female symbol = 32, male symbol = 9). Causes for and type of reoperation were analyzed. Weight loss and comorbidities were compared for different types of reoperations. RESULTS There were no deaths following the reoperations. Band replacement (n = 18), band repositioning (n = 7), conversion to sleeve gastrectomy (SG, n = 2) and Roux-en-Y gastric bypass (RYGBP, n = 2) or band removal without any further substitution (n = 12) were performed as first reoperation. Seven patients had a second reoperation: RYGBP (n = 3), SG (n = 1), or band removal (n = 3). Median follow-up since reoperation was 56 months (range 7-113). Excess weight loss (EBWL%) of patients was 59.4% after RYGBP (n = 5), 45.1% after re-banding (n = 18), and 33.4% after SG (n = 2). Comorbidities were further reduced or even resolved after reoperation. Patients whose band was removed without subsequent bariatric procedures lost significantly less weight (n = 13, EBWL% 23.4) than patients with band replacement (n = 18, EBWL% 46.4, p = 0.04). CONCLUSION Laparoscopic reoperation after LAGB is safe and feasible. Reoperation leads to further decrease of BMI and obesity-related comorbidities. Band replacement is a good option for patients with good weight loss after initial LAGB. Alternative procedures, preferably RYGBP, are required for cases of band failure. Overall, RYGBP appears to be the most effective option to induce further weight loss.
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Affiliation(s)
- Marco Bueter
- Department of Surgery I, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Strasse 6, 97080 Wuerzburg, Germany.
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Emergency Sleeve Gastrectomy as Rescue Treatment for Acute Gastric Necrosis Due to Type II Paraesophageal Hernia in an Obese Woman with Gastric Banding. Obes Surg 2008; 18:737-41. [DOI: 10.1007/s11695-007-9374-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 11/15/2007] [Indexed: 12/19/2022]
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Lap-band causing left gastric artery erosion presenting with torrential hemorrhage. Obes Surg 2008; 18:1050-2. [PMID: 18392902 DOI: 10.1007/s11695-008-9439-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
Abstract
A 61-year-old lady presented 2 years after lap-band surgery with hemetemesis. She was stable on admission and band erosion was diagnosed on gastroscopy. Laparotomy was performed to remove the lap band. Upon division of the lap band, torrential hemorrhage from the eroded left gastric artery was encountered. An anterior gastrostomy was done to expose the artery. Intraoperative gastroscopy was also performed to define the cardioesophageal junction. The artery was ligated and the perforation and gastrostomy were repaired. The patient was discharged after 9 days in hospital. This case highlighted the potential injury to the left gastric artery in patients with band erosion presenting with hemetemesis. Torrential bleeding may be encountered upon division of the lap band, and this should be anticipated during laparotomy.
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Affiliation(s)
- Deron J Tessier
- Staff Surgeon, Kaiser Permanente Medical Center, Fontana, California, USA
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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JWM, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts 2008; 1:52-9. [PMID: 20054163 PMCID: PMC6444702 DOI: 10.1159/000113937] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In 2005, for the first time in European history, an extraordinary expert panel named BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European scientific societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective scientific societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past 2 years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.
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Affiliation(s)
- Martin Fried
- Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic.
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Ellison SR, Ellison SD. Bariatric Surgery: A Review of the Available Procedures and Complications for the Emergency Physician. J Emerg Med 2008; 34:21-32. [DOI: 10.1016/j.jemermed.2007.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 05/16/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
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38
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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JWM, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. Interdisciplinary European Guidelines for Surgery for Severe (Morbid) Obesity. Obes Surg 2007; 17:260-70. [PMID: 17476884 DOI: 10.1007/s11695-007-9025-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Martin Fried
- Clinical Center for Minimally Invasive and Bariatric Surgery, Prague, Czech Republic
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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JWM, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond) 2007; 31:569-77. [PMID: 17325689 DOI: 10.1038/sj.ijo.0803560] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.
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Affiliation(s)
- M Fried
- Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic.
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Iannelli A, Dahman M, Facchiano E, Gugenheim J. A simple technique for laparoscopic removal of silicone adjustable gastric banding. J Laparoendosc Adv Surg Tech A 2006; 16:301-4. [PMID: 16796446 DOI: 10.1089/lap.2006.16.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laparoscopic adjustable silicone gastric banding is currently among the most common surgical procedures performed in morbidly obese patients. The safety, reversibility, and technical simplicity of this procedure account for its wide and rapid diffusion. Concern still exists about the long term efficacy of the procedure in achieving weight loss and mechanical complications continue to represent the Achilles' heel of the procedure. Little or no attention has been given in the literature to the technical aspects of band removal. The surgical technique must be as simple and minimally invasive as possible. We report the technique we currently use to remove failed bands.
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Affiliation(s)
- Antonio Iannelli
- Department of Liver Transplantation, Gastrointestinal and Laparoscopic Surgery, Archet 2 Hospital, Nice, France.
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Lyass S, Cunneen SA, Hagiike M, Misra M, Burch M, Khalili TM, Furman G, Phillips EH. Device-Related Reoperations after Laparoscopic Adjustable Gastric Banding. Am Surg 2005. [DOI: 10.1177/000313480507100909] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is considered a relatively safe weight loss procedure with low morbidity. When complications occur, obstruction, erosion, and port malfunction require reoperation. We retrospectively reviewed our experience with 270 consecutive patients who underwent LAGB. Device-related reoperations were performed in 26 (10%) patients. Reoperations were related to the band in 13, to port/tubing in 11, and related to both in 2 patients. Of the 15 band-related problems, it was removed in 5 (2%): slippage (3), intra-abdominal abscess (1), and during emergent operation for bleeding duodenal ulcer (1). Revision or immediate replacement was performed in 10 (4%): slippage (5), obstruction (4), and leak from the reservoir (1). Port/tubing problems were the reason for reoperations in 13 (5%): infection (5), crack at tubing-port connection (6), and port rotation (2). Port removal for infection was followed later by port replacement (average 9 months). Overall, slippage occurred in 8 (3%), obstruction in 4 (1.5%), leak from reservoir in 7 (3%), and infection in 5 (2%) patients. Fifteen device-related problems occurred during our first 100 cases and 12 subsequently ( P = 0.057). Permanent LapBand loss was only 5 per cent, leading to overall rate of 95 per cent of LapBand preservation as a restrictive device.
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Affiliation(s)
- Sergey Lyass
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Monali Misra
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | - Miguel Burch
- From the Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Gary Furman
- From the Cedars-Sinai Medical Center, Los Angeles, California
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42
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Kelly J, Tarnoff M, Shikora S, Thayer B, Jones DB, Forse RA, Hutter MM, Fanelli R, Lautz D, Buckley F, Munshi I, Coe N. Best practice recommendations for surgical care in weight loss surgery. ACTA ACUST UNITED AC 2005; 13:227-33. [PMID: 15800278 DOI: 10.1038/oby.2005.31] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To establish evidence-based guidelines for best practices for surgical care in weight loss surgery (WLS). RESEARCH METHODS AND PROCEDURES We carried out a systematic search of English-language literature on WLS in MEDLINE and the Cochrane Library. Key words were used to narrow the field for a selective review of abstracts. Data extraction was performed, and evidence categories were assigned according to a grading system based on established evidence-based models. RESULTS We assessed types of WLS, recommended guidelines for appropriateness, developed strategies for medical error reduction, established criteria for credentialing of systems and practitioners, and specified research needed for the future. DISCUSSION Surgeon training, credentialing, and type of surgery performed were identified as key factors in patient safety. Other important issues in the delivery of best practice care included appropriate patient selection; use of a multidisciplinary treatment team; facility staffing, equipment, and administrative support; and early recognition and proper management of complications.
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Affiliation(s)
- John Kelly
- Department of Surgery, University of Massachusetts Medical Center, 67 Belmont Street, Worcester, MA 01545, USA.
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Abstract
Bariatric surgery is currently considered the best treatment option for morbid obesity. With the rapid development of laparoscopic techniques, a significant increase in the number bariatric procedures in recent years can be observed. Various surgical techniques to treat morbid obesity have been described, but only few prospective studies compare the different procedures, leading to a lack of evidence for their use. However, from the available literature some general recommendations can be given: (a) preoperative workup in an interdisciplinary team is mandatory, (b) primary bariatric procedures should be performed laparoscopically, and (c) the combination of restrictive and malabsorptive techniques is more efficient than a purely restrictive method, which is also true for the treatment of comorbid diabetes and arterial hypertension. In this paper, we present recent developments in bariatric surgery, with special emphasis on the available evidence for the best treatment of morbidly obese patients.
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Affiliation(s)
- M K Müller
- Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Schweiz
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44
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Abstract
Although laparoscopic adjustable gastric banding has become a widely used surgical modality for the treatment of morbid obesity, the technique and its complications remain fairly unknown to the medical community in general. Late complications occur in 10% to 20% of patients and usually manifest as upper gastrointestinal symptoms such as total food intolerance. However, seemingly unrelated symptoms such as chest pain may be the primary complaint. A rare but important complication to recognize and treat is gastric necrosis due to herniation of the stomach through the band. From the lessons learned with 2 patients and review of the literature, the diagnostic pitfalls and means for achieving a prompt diagnosis are discussed and a management protocol intended for emergency department staff is provided.
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Affiliation(s)
- Serge Landen
- Department of Surgery, Clinique St Elisabeth, Brussels, Belgium
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45
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Spivak H, Hewitt MF, Onn A, Half EE. Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg 2005; 189:27-32. [PMID: 15701486 DOI: 10.1016/j.amjsurg.2004.06.038] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Revised: 06/23/2004] [Accepted: 06/23/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity and its related illness is a primary health concern today. METHODS Five hundred morbidly obese patients (mean age 42 years; mean preoperative weight 123 kg) underwent laparoscopic adjustable gastric banding surgery in a private U.S. hospital setting within a comprehensive multidisciplinary bariatric program. Patients were followed up to 36 months. Comorbidity status was assessed for 163 patients who completed > or =18 months' follow-up by comparing medications (type and dosage) prescribed for each comorbid condition before surgery and at follow-up. RESULTS At 36 months after surgery, mean body mass index (BMI) had decreased from 45.2 to 34.9 kg/m(2) and mean percent excess weight loss (%EWL) was 47%. Complications were as follows: gastric pouch dilatation (6.8%), slippage (2.8%), and stoma obstruction (0.6%). There was no mortality. Resolution or improvement of comorbidities were as follows: gastroesophageal reflux disease (GERD) (87%; usually immediately postsurgery), asthma (81.8%), diabetes (66%), dyslipidemia (65.5%), hypertension (48%), and sleep apnea (33%). CONCLUSIONS Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.
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Affiliation(s)
- Hadar Spivak
- Park Plaza Hospital Professional Bldg., 1200 Binz, Ste. 1470, Houston, TX 77004, USA.
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46
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Affiliation(s)
- Alexander P Nagle
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA
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47
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Irtan S, Forestier D, Scesa JL, Nini E, Gayard P, Pezet D. Nécrose gastrique après gastroplastie. Presse Med 2004; 33:718-20. [PMID: 15257229 DOI: 10.1016/s0755-4982(04)98728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Over the past ten years, laparoscopic surgery in the treatment of morbid obesity has expanded. However, there are few publications describing its side effects, notably the occurrence of gastric necrosis. OBSERVATION Two years after laparoscopic-banding for morbid obesity, a case of acute gastroenteritis in a 45 Year-old woman proved to be a gastric necrosis. COMMENTS Relatively unknown, this complication is generally revealed by non-specific clinical signs. Only emergency oeso-gastro-duodenal opacification permits diagnosis. Early diagnosis permits conservative treatment before the onset of necrosis. CONCLUSION Care must be taken when using this technique, which has not yet proved its innocuousness, and regular follow-up of the patient is crucial.
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Affiliation(s)
- Sabine Irtan
- Service de chirurgie digestive, Hôtel Dieu, Clermont-Ferrand.
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Roy-Choudhury SH, Nelson WM, El Cast J, Zacharoulis D, Kirkwood B, Sedman PC, Royston CMS, Breen DJ. Technical aspects and complications of laparoscopic banding for morbid obesity—a radiological perspective. Clin Radiol 2004; 59:227-36. [PMID: 15037134 DOI: 10.1016/j.crad.2003.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Revised: 07/21/2003] [Accepted: 07/29/2003] [Indexed: 11/17/2022]
Abstract
Morbid obesity is a significant clinical problem in the western world. Various surgical restrictive procedures have been described as an aid to weight reduction when conservative treatments fail. Adjustable laparoscopic gastric banding (LAPBAND) has been popularized as an effective, safe, minimally invasive, yet reversible technique for the treatment of morbid obesity. Radiological input is necessary in the follow-up of these patients and the diagnosis of complications peculiar to this type of surgery. In this review we will highlight the technical aspects of radiological follow-up and the lessons learnt over the last 5 years.
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Affiliation(s)
- S H Roy-Choudhury
- Department of Radiology, Hull and East Yorkshire Hospitals NHS Trust, Kingston Upon Hull, UK
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49
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Sarker S, Herold K, Creech S, Shayani V. Early and Late Complications following Laparoscopic Adjustable Gastric Banding. Am Surg 2004. [DOI: 10.1177/000313480407000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
There is limited U.S. data on short- and long-term complications of laparoscopic adjustable gastric banding (LAGB) as a treatment option for morbid obesity. Hereafter, we present our experience with the first 154 consecutive LAGBs performed at Loyola University Medical Center. Inpatient and outpatient charts were reviewed retrospectively for all patients undergoing LAGB between November 2001 and February 2003 for perioperative morbidity and mortality and repeat operations. Thirty-seven men (24%) and 117 women (76%) underwent LAGB in a 16-month period. There was one (0.6%) death from postoperative myocardial infarction (MI) and one (0.6%) pulmonary embolism. Six (3.9%) patients required readmission to the hospital for dehydration. During a mean follow-up of 33 weeks (range, 4–69 weeks), 14 (9%) patients required repeat operations. There were five (3.2%) band slippages and one (0.6%) gastric erosion. Three bands were removed laparoscopically. Three slippages were revised laparoscopically. One patient underwent laparoscopic cholecystectomy. Seven patients (4.5%) required port revisions for catheter disconnection (4), leak at port site (2), or flipped port (1). LAGB is a safe operative approach for the management of morbid obesity. The incidence of postoperative complications can be minimal with application of a standardized technique. LAGB should be strongly considered for morbidly obese patients who have failed nonoperative management.
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Affiliation(s)
- Sharfi Sarker
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Katherine Herold
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Steve Creech
- Oncology Institute, Loyola University Medical Center, Maywood, Illinois
| | - Vafa Shayani
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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