Laparoscopic adjustable gastric banding. A prospective randomized study comparing the Swedish Adjustable Gastric Band and the MiniMizer Extra: one-year results

Laparoscopic Adjustable Gastric Banding: a Prospective Randomized Clinical Trial Comparing 5-Year Results of two Different Bands in 103 Patients

BACKGROUND

Various types of adjustable gastric bands are used during LAGB, but there is insufficient data comparing different bands in the long term. We carried out a prospective randomized study to compare two different bands.

METHODS

Between January 1, 2009 and January 31, 2010, 103 morbidly obese patients were randomized between SAGB and MiniMizer Extra adjustable gastric bands. The SAGB was used in 49 and MiniMizer Extra in 54 patients. Weight loss, comorbidities, long-term complications, and quality of life were evaluated after 5 years.

RESULTS

Patient baseline characteristics were similar in the two groups. The mean patient age was 45.9 ± 11.7 years, and mean preoperative BMI was 47.5 ± 7.3 kg/m². A total of 90 of 103 patients (87.3 %) completed the 5-year follow-up. The mean excess weight loss was 44.1 and 50.3 % in SAGB and MiniMizer groups, respectively (p = 0.14). A proportion of patients who reached a BMI < 35 kg/m² was significantly larger in MiniMizer Extra group (52.9 vs 25.5 %; p = 0.01). Complications developed in 15 patients (14.5 %) and consisted of 5 band erosions, 4 port-related complications, 3 band slippages, and 3 band intolerances. All five band erosions developed in MiniMizer Extra group, but the difference was not significant (p = 0.058). No difference was found regarding postoperative complications, resolution of comorbidities, and quality of life between compared groups.

CONCLUSIONS

SAGB and MiniMizer Extra bands demonstrated similar long-term results regarding the weight loss, resolution of comorbidities, morbidity, and quality of life.

The influence of laparoscopic vs. open gastric bypass on hemodynamic function in morbidly obese patients during general anesthesia

INTRODUCTION

The open or laparoscopic procedure has an important influence on the hemodynamic function in morbidly obese patients undergoing bariatric surgery. The anesthesiologist and surgeon must be aware of changes in hemodynamic performance during laparoscopy or laparotomy under general anesthesia.

AIM

TO EVALUATE AND COMPARE THE HEMODYNAMICS IN TWO TYPES OF SURGERY: open vs. laparoscopic.

MATERIAL AND METHODS

After obtaining the local ethics committee approval 60 morbidly obese (MO) patients (body mass index ≥ 40 kg/m(2)) scheduled for elective open or laparoscopic Roux-en-Y gastric bypass were included. Patients were allocated to study groups depending on the scheduled type of surgery (no randomization). General anesthesia with sevoflurane was performed. The hemodynamic parameters were recorded using a HemoSonic 100 device - a transesophageal Doppler measurement at time points: T1 - initial, T2 - after creating pneumoperitoneum (group PP) or opening the abdomen (group OP).

RESULTS

Complete data were collected on 28 patients in group LP and 21 in group OP. There was no statistical difference between groups in demographic data. At time point T2 in both groups the parameters stroke volume, peak velocity and cardiac index decreased, and total systemic vascular resistance increased significantly compared to T1 (p < 0.05). In group LP the parameters cardiac output and acceleration (Acc) of blood decreased significantly compared to T1 (p < 0.05). There were significant differences between groups (p > 0.05) in cardiac output, total systemic vascular resistance and Acc, which were significantly higher in the OP group. In both groups mean arterial pressure increased and heart rate stayed similar to T1 with no significant difference (p > 0.05). No complications were observed.

CONCLUSIONS

Pneumoperitoneum has a significant negative influence on hemodynamic function during laparoscopic bariatric procedures compared to open surgery in morbidly obese patients.

Metabolic changes one year after laparoscopic adjustable gastric banding operation in morbidly obese subjects

Introduction

Laparoscopic adjustable gastric banding (LAGB) is effective for weight reduction in severely obese patients. However, the data about its effect on metabolic syndrome (MS) are limited.

Aim

To assess weight loss and changes of metabolic parameters 1 year after LAGB in a prospective, nonrandomized single center cohort study in morbidly obese subjects.

Material and methods

Physical examination, body weight (BW) parameters and metabolic profile were assessed at baseline and 1 year after LAGB in morbidly obese subjects. The incidence of MS was evaluated according to National Cholesterol Education Program Adult Treatment Panel III criteria.

Results

One year after the operation data from 90 patients out of 103 were available. Mean excess weight (EW) loss of 33.1% was associated with a significant improvement in all metabolic parameters: decrease of hypertension by 15.8%, hypertriglyceridemia by 42.6%, and hyperglycemia by 46.3%; and increase in high density lipoprotein cholesterol by 48.3%. This resulted in the resolution of MS in 44.2% of subjects. The significant change in the distribution of MS components was observed with the highest frequency of 4 components before and 2 components after surgery. Patients with MS at baseline lost 29.9% of EW compared to 44.3% in those without MS (p = 0.009).

Conclusions

The LAGB resulted in effective reduction of BW parameters in morbidly obese subjects 1 year after the operation. Along with the weight loss, resolution of MS and a significant shift towards decrease in the number of MS components was observed. Patients with MS were more resistant to the weight loss.