title: Laparoscopic adjustable esophagogastric banding: preliminary results.
abstract: BACKGROUND
  Laparoscopic gastric banding is effective in surgical treatment of morbid obesity, but has had the drawback of specific complications, like slippage and gastric erosion. To prevent such complications, modifications have been used, including high retrogastric positioning above the bursa omentalis, complete anterior fixation by gastro-gastric stitches over the band, and reduction of the pouch volume to < or = 15 ml. These technical variants may induce dysphagia.
  
  
  METHODS
  We adopted a different technique, consisting of placement of the band (9.75 cm BioEnterics Lap-Band) around the esophagus just above the cardia, to induce an amplification of the dysphagic mechanism. No fixation stitches were used.
  
  
  RESULTS
  From January 1999 to March 2001, 80 consecutive patients (16 males, 64 females, mean age 41 years, average BMI 45) were operated this way. All operations were completed laparoscopically. However, in 1 patient the procedure had to be interrupted for bleeding from a large fatty liver injury by the retractor. Complications included 2 cases of slippage: an early one after 24 h, requiring surgical removal, and a late one after 9 months, treated by laparoscopic repositioning. The third complication, a reactive esophageal stenosis, occurred in a transsexual male on estrogen treatment, that needed replacement with a wider Swedish band. Band adjustment was required in 28 patients, one time in 22 cases and twice in the other 6. Mean BMI decreased from 45 to 38 after 6 months, remaining at 37 after 24 months, while excess weight was reduced by 50% at 24 months.
  
  
  CONCLUSIONS
  The technique has a re-educational function, in that patients are induced to chew thoroughly, to introduce small morsels of food and to prolong the mastication time, in order to avoid dysphagia. Laparoscopic adjustable esophagogastric banding gave no problem if well positioned, and promoted new alimentary habits through a dysphagic mechanisms, inducing significant excess weight loss.
authors.affiliation: Department of General Surgery, Bellaria Hospital, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: Francesco Domenico
authors.initials: FD
authors.lastname: Capizzi
authors.forename: Sergio
authors.initials: S
authors.lastname: Boschi
authors.forename: Mauro
authors.initials: M
authors.lastname: Brulatti
authors.forename: Andrea
authors.initials: A
authors.lastname: Cuppini
authors.forename: Marco
authors.initials: M
authors.lastname: Di Domenico
authors.forename: Luciano
authors.initials: L
authors.lastname: Fogli
authors.forename: Vito
authors.initials: V
authors.lastname: Papa
authors.forename: Patrizio
authors.initials: P
authors.lastname: Patrizi
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages / Q000009:adverse effects*; D015992:Body Mass Index; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011859:Radiography; D013997:Time Factors; D015431:Weight Loss / Q000502:physiology