Graft Survival and Complications after Laparoscopic Gastric Banding for Morbid Obesity—Lessons Learned from a 12-Year Experience

Abstract

Laparoscopic adjustable gastric banding (LAGB) has been considered by many as the treatment of choice for morbid obesity because of its simplicity and encouraging early results. The aim of this prospective study was to critically assess the effects, complications, and outcome after LAGB in the long-term, based on a 12-year experience. Between June 1998 and June 2009, all patients with implantation of a LAGB have been enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications, re-operation rate, and graft survival. LAGB was performed in 167 patients (120 female, 47 male) with a mean age of 40.1±5.2 years. Operative mortality was 0%, overall 1.2% (not band-related). Overall patient follow-up was 94.0%. Mean excess weight loss (EWL) after 1, 2, 5, 8, and 10 years was 31.1±7.5% (p<0.005), 44.2±6.5% (p< 0.001), 50.3±6.9% (p<0.001), 51.7±6.3% (p<0.001), and 48.8±6.0% (p<0.001), respectively. The non-responder rate (EWL<30%) after 2, 5, 8, and 10 years was 24.5%, 18.3%, 12.5%, and 16.6%, respectively. The early complication rate (<30 days) was 7.8% (13/167), with 10 minor and three major complications. Late complications (>30 days) occurred in 40.1% (67/167), of whom seven were minor and 60 were major complications (three band infections, two band migrations, 11 band leakages, two slippings/pouch dilatations, two band intolerances, and 40 esophageal dilatations). The overall re-operation rate was 20.4% (34/167). The graft survival of the implanted band after 2, 5, 8, 10, and 12 years was 98.8%, 94.0%, 86.8%, 85.0%, and 85.0%, respectively. The failure rate of the procedure after 2, 5, 8, and 10 years was 25.7%, 24.3%, 25.7%, and 31.6%, respectively. In the present long-term highparticipation follow-up study, LAGB is a safe and effective surgical treatment for morbid obesity. However, the high complication, re-operation, and long-term failure rates lead to the conclusion that LAGB should be performed in selected cases only, until reliable criteria for patients at low risk for long-term complications are developed.

Surgical Management of Obesity and the Relationship to Cardiovascular Disease

“…58 Gastric band patients are inherently predisposed to band slippage, leakage, and erosion, resulting in reintervention rates as high as 20%. 59 Incisional and internal herniation can complicate open and laparoscopic procedures, respectively. Given that presenting symptoms and clinical signs may be subtle, a high index of suspicion is critical for timely surgical exploration, reduction of the hernia, and resection of nonviable bowel.…”

Bariatric surgery for treatment of obesity

“…27 Gastric band patients are inherently predisposed to developing band-related complications, including band slippage, band deflation (from ruptured balloon or inflation port breakage) and erosion, resulting in reintervention rates as high as 20%. 28 Band salvage procedures include endoscopic or laparoscopic removal of the band in case of erosion, laparoscopic repositioning in the event of band slippage or laparoscopic replacement of the band in the case of leakage. Incisional and internal herniation can complicate both open and laparoscopic bariatric procedures.…”

Seguimento tardio em pacientes com banda gástrica

“…Reoperation was 52.9% due to some complication 8. Their results were satisfactory in the category of weight loss in patients who still kept the band. At the end of the study, only 53.6% of patients continued with the original band, 17.8% were reoperated replacing the band with a new one, and 28.6% had their band removed 7. Swansoin et al 11 studied 86 patients and reached the same conclusions 9 . However, they found 25% increase in symptoms of gastroesophageal reflux 11 .…”

“…Sleeve gastrectomy was required in 14 patients (11.5%) 5 . In another study 9 , evaluations were conducted from June 1998 to June 2009 in a total of 167 patients, 120 women. Follow-up was done on 94% of the participants.…”