title: Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding.
abstract: During the past decade, laparoscopic adjustable gastric banding has become the most popular surgical procedure in treating morbid obesity. On the other hand, significant drawbacks such as inadequate long-term weight loss, a high prevalence of reoperations, and frequent postoperative symptoms have been reported in the literature. This analysis summarizes our Department's experience with this operation. Thirty-one patients (27 women and 4 men) with a mean body mass index of 46.5 kg/m(2) (range, 38.3-59.8 kg/m(2)) were operated upon laparoscopically between September 1997 and January 2003. The preoperative work-up of all patients included a psychological evaluation. Mean follow-up was 59.3 months (range, 19-84 months). Sixteen patients had esophageal pH-metry and 18 patients had upper gastrointestinal endoscopy preoperatively and postoperatively. Data were collected prospectively during the outpatient visits. Mean preoperative excess weight was 65.6 kg (range, 37.4-96.1 kg). Mean excess weight loss after 12, 24, 36, 48, 60, 72, and 84 months was 40.3%, 50.5%, 51.9%, 48.9%, 46.2%, 51.8%, and 30.2%, respectively. In total, six patients (19.4%) had an abdominal reoperation, including four patients (12.9%) for band removal. Upper gastrointestinal endoscopy was performed in 18 patients after 30.1 months (range, 5-67 months), showing a high prevalence of esophagitis (30.0%; grade 1: n=3, grade 2: n=3). Conversely, postoperative esophageal pH-metry performed in 16 patients was pathologic in 43.8%. Laparoscopic adjustable gastric banding produces significant weight loss even after long-term follow-up. However, the reoperation rate is high and postoperative symptoms are frequent. The high incidence of gastroesophageal reflux and esophagitis remains a matter of concern.
authors.affiliation: Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany. ch.gutschow@t-online.de
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: Peter
authors.initials: P
authors.lastname: Collet
authors.forename: Klaus
authors.initials: K
authors.lastname: Prenzel
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Paul M
authors.initials: PM
authors.lastname: Schneider
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003680:Deglutition Disorders / Q000209:etiology; D020878:Device Removal; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology*; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D005773:Gastroscopy; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D015431:Weight Loss