Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection.
BACKGROUND
The purpose of this study was to assess factors of clinical importance in morbidly obese patients having a laparoscopically adjustable gastric band (LAP-BAND) implanted in order to achieve weight loss.


METHODS
Preoperative evaluation of hiatus hernia and esophageal (dys)motility were compared with the need for reoperation. Results are presented for the first 50 consecutive patients entered.


RESULTS
Nine of the first 50 patients required reoperation (18%). Five (10%) were for LAP-BAND slippage on the stomach. Of these five, reoperation was required in four of 12 (33%) with hiatus hernia (P = 0.0093); three of nine (33%) with a motility disorder (P = 0.025); and three of six (50%) with both hiatus hernia and a motility disorder (P = 0.0076).


CONCLUSIONS
We identify two factors, hiatus hernia and esophageal dysmotility, which are associated, both independently as well as in combination, with reoperation for LAP-BAND slippage. Both patients and their physicians should consider these data when considering the LAP-BAND as possible therapy for morbid obesity.
Greenstein
R J
RJ
Surgery, VAMC, Bronx, NY, USA. BGAxis@aol.com
Nissan
A
A
Jaffin
B
B
D015154:Esophageal Motility Disorders / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data