Laparoscopic gastric bypass with silicone band in a pig model: prevention of anastomotic dilatation -- feasibility study.
BACKGROUND
Morbid obesity has become a major global health problem. Surgery remains the only effective treatment for patients with severe obesity, because diet reduction methods and pharmacologic agents have not resulted in long-term weight reduction. Gastric bypass (GBP) can provide adequate weight loss, but after some years, dilatation of the gastric pouch and outlet may lead to weight regain by allowing the patient to increase food intake.


METHODS
2 groups of 6 pigs underwent laparoscopic GBP. In the first group, a non-adjustable silicone band (Proring-band, IOC, Innovative Obesity Care, Saint Etienne, France) was positioned 1 cm proximal to the gastrojejunal anastomosis. In the second group, the device used to stabilize the gastric pouch was an adjustable silicone band (Mid-band, Medical Innovation Developpement, Villeurbanne, France). Weight loss, complications and histological reaction were evaluated after 3 months.


RESULTS
Mortality rate was 25% (cardiac arrythmia in 2 pigs). Conversion rate was 25%. The positioning of the band was more difficult with the Mid-band because of its larger size and the presence of the catheter. The average weight change in the Proring group was 15.8 kg (3.5-25.1 kg), and in the Mid-band group was 12.0 kg (6.2-15.1 kg). Morbidity consisted of one intragastric migration of the Proring band into the gastrojejunal anastomosis, and one infection of the port in the Mid-band group treated by removal of the port and antibiotics.


CONCLUSIONS
Use of silicone devices may be safe and effective in the prevention of pouch or outlet dilatation after GBP.
Nocca
David
D
Minimally Invasive Surgery Center, Mount Sinai Hospital, New York, USA. d.nocca@wanadoo.fr
Gagner
Michel
M
Abente
Federico Cuenca
FC
Del Genio
Gian Mattia
GM
Ueda
Kazuki
K
Assalia
Ahmad
A
Rogula
Thomas
T
Bertani
Diego
D
D000713:Anastomosis, Roux-en-Y; D000818:Animals; D004108:Dilatation, Pathologic / Q000517:prevention & control*; D004195:Disease Models, Animal; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D015905:Gastric Balloon; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D011897:Random Allocation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012828:Silicones; D015996:Survival Rate; D013552:Swine
D012828:Silicones