Abstract
Background
Slippage of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage Incomplete suturing often is responsible for anterior slippage. A randomized prospective study was constructed to determine whether laparoscopic esophagogastric placement (EGP) is associated with a lower incidence of postoperative slippage and pouch dilation than RGP.
Methods
Morbid obese patients presenting for LASGB were randomized to undergo either an EGP (n=50) or an RGP (n=51). Patients were blinded to which procedure they underwent, and follow-up date were obtained by a blinded independent investigator. Standardized clinical and radiologic controls were used to assess pouch enlargement and slippage.
Results
Operating time was similar for the two procedures (54.5 min for EGP vs 58 min for RGP). There was no significant difference in postoperative weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagus dilation, or postoperative quality of life. There were two postoperative slippages and one pouch dilation in the RGP group and no postoperative complication in the EGP group.
Conclusions
The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower frequency of postoperative complications than its placement by the RGP technique. Clear anatomic landmarks are a benefit to education and to the learning curve for LASGB.
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References
Alvarez-Cordero R, Castillo-Gonzales A, Ramirez-Wiela G (1999) The “Mexican technique” for the laparoscopic placement of adjustable gastric band. Abstract of the 16th Annual Meeting of the American Society for Bariatric Surgery, San Diego, 1999. Obesity Surg 9: 135–143
Balssiger BM, Luaue-de Leon E, Sarr MG (1997) Surgical treatment of obesity: who is an appropriate candidate? Mayo Clin Proc 72: 551–558
Belachew M, Legrand M, Deffechereux Th (1994) Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity. Surg Endosc 8: 1354–1356
Belachew M, Legrand M, Vincent V, Lismonde M, Le Doche N, Deschamps V (1999) Laparoscopic adjustable gastric banding. World J Surg 22: 955–963 DOI: 10.1007/s002689900499
Belva P, Takieddine M, Lefebvre JC, Vaneikem P (1997) How to reduce complication rate in laparoscopic gastric banding. Obesity Surg 7: 303–309
Cadiere GB, Bruyns J, Himpens J, Favretti F (1994) Laparoscopic gastroplasty for morbid obesity. Br J Surg 81: 1524–1527
Desaive C (1996) A critical review of a personal series of 1000 gastroplasties. Inter J Obesity 19: 256–360
Favretti F, Cadiere GB, Segato G, Bruyns G, De Marchi F, Himpens J, Foletto M, Lise M (1995) Laparoscopic adjustable silicone gastric banding: technique and results. Obesity Surg 5: 364–371
Favretti F, Cadière GB, Segato G, Himpens J, Busetto L, De Marchi F, Vertruyen M, Enzi G, De Luca M, Lise M (1997) Laparoscopic adjustable silicone gastric banding: how to avoid complications. Obesity Surg 7: 352–358
Kunath U, Memari B (1995) Laparoskopisches “Gastric Banding” zur Behandlung der pathologischen Adipositas. Chirurg 66: 1263–1267
Kuzmak LI (1986) A preliminary report on silicon gastric banding for morbid obesity. Clin Nutr 5: 73–77
Morino M, Toppino M, Garrone C (1997) Disappointing long-term results of laparoscopic adjustable silicone gastric banding. Br J Surg 84: 868–869
O’Brien PE, Brown WA, Smith A, McMurrick PJ, Stephens M (1999) Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 86: 113–118
Paganini AM, Guerrieri M, Feliciotti F, Lezoche E (1997) Laparoscopic adjustable silicone gastric banding (LASGB) for the treatment of morbid obesity. Surg Technol Intern 5: 147–150
Weiner R (1999) Manual Laparoskopisches Gastric Banding. Barth Verlag, Heidelberg, Leipzig
Weiner R, Datz M, Wagner D, Bockhorn H (1999) Quality of life outcome after laparoscopic adjustable gastric banding for morbid obesity. Obes Surg 9: 539–545
Weiner R, Emmerlich V, Bochhorn H, Wagner D (1998) Management und Therapie von Komplikationen nach “gastric-banding” wegen morbider Adipositas. Chirurg 69: 1082–1088
Weiner R, Wagner D, Bockhorn H (1999) Laparoscopic gastric banding for morbid obesity. J Laparoendosc Adv Surg Technol 9: 23–30
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Online publication: 28 September 2000
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Weiner, R., Bockhorn, H., Rosenthal, R. et al. A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity. Surg Endosc 15, 63–68 (2001). https://doi.org/10.1007/s004640000303
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DOI: https://doi.org/10.1007/s004640000303