Postoperative management of laparoscopic gastric banding.
BACKGROUND
The authors investigated the postoperative management of morbidly obese patients treated by laparoscopic adjustable gastric banding (LAGB) with the Lap-Band System.


METHODS
The 3-year postoperative band management is presented in 379 morbidly obese patients, divided according to intra-operative band filling and quartiles of maximum postoperative band filling.


RESULTS
LAGB resulted in a 40.8 +/- 24.5 percent excess weight loss (%EWL). Stoma stenosis occurred in 87 patients (23.0%), pouch dilatation in 52 (13.7%) and esophageal dilatation in 22 (5.8%). Most band-related complications were controlled by simple band deflation. The mean number of postoperative band adjustments was 2.3 +/- 1.7, and mean maximum band filling after surgery was 2.8 +/- 1.2 ml. Weight loss at 3 years was identical in 205 patients who had the band completely unfilled at surgery and in 174 patients who had the band filled with 1 to 3 ml of sterile saline. The rate of band-related complications was significantly lower in the first group. No differences in %EWL were observed between quartiles of maximum band filling after surgery. The rate of band-related complications increased with increasing levels of postoperative maximum band filling. In patients with the band filled with < 3.0 ml of sterile saline at 6 months, the inflation of further saline produced a dose-related increase in the rate of weight loss. In patients with the band filled with > 3.0 ml of sterile saline at 6 months, the inflation of further saline was associated with a reduced %EWL.


CONCLUSIONS
Postoperative adjustability of the Lap-Band was useful in the treatment of band-related complications and was able to significantly influence the rate of weight loss. On the other hand, aggressive postoperative band filling was associated with an increased rate of complications.
Busetto
Luca
L
Obesity Unit, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy. luca.busetto@unipd.it
Segato
Gianni
G
De Marchi
Francesco
F
Foletto
Mirto
M
De Luca
Maurizio
M
Favretti
Franco
F
Enzi
Giuliano
G
D000328:Adult; D015897:Comorbidity; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011182:Postoperative Care; D015431:Weight Loss