title: Prospective study of 250 patients undergoing laparoscopic gastric banding using the two-step technique: a technique to prevent postoperative slippage.
abstract: BACKGROUND
  The use of LAP-BAND adjustable gastric banding (LAGB) has gained tremendous popularity, but creation of the retrogastric tunnel is a considerable challenge, especially in the surgeon's early experience, and is associated with up to 10% band slippage and occasional gastric perforation. The two-step technique involves a crural dissection toward the angle of His through a pars flaccida approach. The technique facilitates passage of the band with no extensive posterior gastric wall dissection.
  
  
  METHODS
  A prospective study investigated 250 patients (207 women and 43 men) who underwent LAGB from January 1999 to May 2002 using a two-step dissection technique. The mean age of these patients was 37 years (range, 18-58 years). Their mean preoperative weight was 120 kg (range, 90-169 kg), and their mean body mass index was 44 kg/m2 (range, 36-68 kg/m2).
  
  
  RESULTS
  All the procedures except two were completed laparoscopically, and there were no deaths. The mean operative time was 61 min (range, 35-150 min), and the mean hospital stay was 1.2 days (range, 1-5 days). At 3 years, the mean body mass index had decreased from 44 kg/m2 to means of 39.9, 37.3, 34.4, 32.4, and 31.7 kg/m2 at 3, 6, 12, 24, and 36 months, respectively. The mean excess weight loss was 42.1% at 1 year, 51.4% at 2 years, and 55.5% at 3 years. There were four band slippages (1.6%), no band erosion, and no major morbidity.
  
  
  CONCLUSIONS
  The use of LAGB with the two-step technique is technically simple, avoids intimate posterior gastric wall dissection, and facilitates tight posterior band support. It therefore is associated with only minimal perioperative complications and a low slippage rate.
authors.affiliation: Department of Surgery B, Beilinson Medical Center, Petah-Tikva, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Rubin
authors.forename: H
authors.initials: H
authors.lastname: Spivak
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors