Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years.
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) is considered the least invasive surgical option for morbid obesity. It is less efficient than gastric bypass in weight loss, but has the advantage of being potentially reversible and can improve the quality of life if mortality and morbidity are low.


METHODS
Between 1996 and 2003, 1,000 patients underwent LAGB. There were 896 women and 104 men with mean age 40.4 years (16.3-66.3). Preoperative mean BMI was 44.3 kg/m(2).


RESULTS
There were no deaths. Cumulative rate of complications was 192 (19.2%). 12 were life-threatening (1.2%): gastric perforation (n=4), acute respiratory distress (n=2), pulmonary embolism (n=2), migration (n=3), and gastric necrosis (n=1). 111 patients required an abdominal reoperation (11.1%) for perforation (n=2), slippage (n=78), migration (n=3), necrosis (n=1), esophageal dilatation (n=2), incisional hernias (n=4) and port problems (n=21). Before October 2000, we used the perigastric technique, and the slippage rate was 24% (91 / 378 ).Then, we changed to the pars flaccida approach and the slippage rate fell to 2% (13 / 622). The pars flaccida approach demonstrated safety in relation to both risks of perforation and slippage.


CONCLUSIONS
The cumulative complication rate increased to 3-4 years, and then decreased with experience and technical improvement. Concerns of long-term follow-up should be migration and esophageal dilatation, which seem to be rare at 3 years.
Chevallier
Jean-Marc
JM
Departments of Digestive Surgery and Nutrition, Hopital Européen Georges Pompidou, 20-40 rue Leblanc, 75908 Paris cedex 15, France. jean-marc.chevallier@hop.egp.ap-hop-paris.fr
Zinzindohoué
Franck
F
Douard
Richard
R
Blanche
Jean-Philippe
JP
Berta
Jean-Louis
JL
Altman
Jean-Jacques
JJ
Cugnenc
Paul-Henri
PH
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015391:Gastroplasty; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome