title: Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years.
abstract: 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.
authors.affiliation: 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
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chevallier
authors.forename: Franck
authors.initials: F
authors.lastname: Zinzindohoué
authors.forename: Richard
authors.initials: R
authors.lastname: Douard
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Blanche
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Berta
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Altman
authors.forename: Paul-Henri
authors.initials: PH
authors.lastname: Cugnenc
mesh_terms: 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