[Video-laparoscopic placement of adjustable gastric banding (lap-band) in the treatment of morbid obesity. Preliminary results after 407 interventions].
BACKGROUND
Morbid obesity is the most frequent nutritional disorder in developed countries. Bariatric surgery is one option for the definitive treatment of this disorder. We present 407 patients who underwent implantation of adjustable silicone gastric banding. Ninety-four percent of the patients were satisfied with the procedure and its results.


METHODS
We performed a retrospective study in the Surgery Department of the Nordwestkrankenhaus teaching hospital of the University of Frankfurt. From April 1996 to January 2000 we performed laparoscopic placement of adjustable silicone gastric banding in 407 patients, using Kuzmak's technique. Mean body mass index was 49.1 and mean weight was 139.2 kg. We describe the patient selection method and provide a detailed description of the technique and its possible problems.


RESULTS
There was no operative or postoperative mortality. None of the patients required conventional surgery. Mean operating time was 62 minutes (including operating times during the learning period). Mean hospital stay was 5 days. We performed 24 (5,89%) reinterventions: 11 for displacement, 2 for erosion, 4 for infection of the reservoir, 2 due to review of the reservoir to prevent penetration and 4 due to dilatations of the pouch (changing the banding from a retrogastric to a retroesophageal position); one patient requested removal of the banding. Follow-up was performed at months 1, 6, 9 and 12. Mean weight loss was 28 kg at 6 months and 54 kg at 1 year. Mean weight loss in patients followed-up for 2 years was 58 kg. A total of 94.9% of the patients were satisfied with the procedure.


CONCLUSIONS
Laparoscopic implantation of adjustable gastric banding (Lap-Band) combines the aims of conventional gastroplasty with the advantages of laparoscopic surgery in terms of postoperative morbidity and minimal invasiveness.
Blanco Engert
R
R
Departamento de Cirugía General, Hospital Nordwest Fráncfort del Meno, Alemania. rblanco@medicosmix.com
Gascon
M
M
Weiner
R
R
Rosenthal
R
R
Brasesco
O
O
Wagner
D
D
Martin Esteban
M
M
Bockhorn
H
H
D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012828:Silicones; D020535:Video-Assisted Surgery; D015431:Weight Loss
D012828:Silicones