Results and complications after laparoscopic adjustable gastric banding in super-obese patients, using the Swedish band.
BACKGROUND
Laparoscopic adjustable gastric banding is effective in inducing weight loss, as well as being minimally invasive, totally reversible, and adjustable to the patient's needs. The aim of this study was to assess the efficacy and safety of adjustable gastric banding with the Swedish band (SAGB) in super-obese patients.


METHODS
Between January 1996 and December 2003, 682 patients (570 women, 112 men) underwent SABG implantation. In these patients, there were 60 super-obese patients with a BMI >/= 50 kg/m(2). Two groups of patients were analyzed: Group 50 (n = 30 patients) with a BMI 50-54 kg/m(2) and Group 55 (n = 30 patients) with a BMI >/= 55 kg/m(2). 13 different surgeons (9 general and 4 bariatric surgeons) performed the SAGB. All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized data bank.


RESULTS
60 patients (8.8%) out of 682 were super-obese and entered the study. Mean %EWL was 39.2 at 1 year and 60.4 at 4 years, BMI fell from 55.5 to 34.7 at 4 years. The complication rate was 26.7% (16/60). General surgeons 12/60 (20%) had more complications than bariatric surgeons 4/60 (6.7%). In Group 50, mean %EWL was 42.1 at 1 year, 55.9 at 2 years, 61.5 at 3 years and 59.9 at 4 years. BMI fell from 51.8 to 33.2 at 4 years. Postoperative complications occurred in 6/30 patients (20%): pouch dilatation (n=2), band migration (n=2) and band leakage (n=2). In Group 55, mean %EWL was 36.8 at 1 year, 55.3 at 2 years, 55.8 at 3 years, and 59.4 at 4 years. BMI fell from 59.1 to 36.4 at 4 years. Postoperative complications occurred in 10/30 patients (33.3%): pouch dilatation (n=2), band migration (n=3) and band leakage (n=5). There was no mortality.


CONCLUSIONS
SAGB is an effective procedure for the surgical treatment of super-obesity. Because of the high complication rate, super-obese patients should only be treated by experienced bariatric surgeons.
Mittermair
Reinhard P
RP
Department of Surgery, University Hospital Innsbruck, Medical University Innsbruck, Austria. reinhard.mittermair@tirol.com
Aigner
Franz
F
Nehoda
Hermann
H
D000328:Adult; D001317:Austria; D015992:Body Mass Index; D004867:Equipment Design; D004869:Equipment Safety; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D015905:Gastric Balloon; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss