title: Avoiding complications after laparoscopic esophago-gastric banding: experience with 400 consecutive patients.
abstract: BACKGROUND
  Among bariatric operations, laparoscopic adjustable gastric banding (LAGB) has been the preferred one in Europe and Australia, and has become recently popular in the USA. Like every surgical procedure, however, it is not devoid of specific complications, like slippage, band erosion, outlet obstruction and port problems. Assuming that the absence of the pouch may avoid postoperative slippage, we introduced the technique of esophago-gastric placement, instead of the original gastric banding technique. A further technical variant, introduced in June 2002, consists of suturing the gastric fundus to the left hemidiaphragm, using two non-resorbable sutures and pledgets.
  
  
  METHODS
  Between January 1999 and July 2005, 400 LAGBs have been placed in 90 males and 310 females, with the technical variants above. Mean age was 42 (range 17-69 years), and mean BMI was 44.8 kg/m(2) (range 33-67).
  
  
  RESULTS
  Mean hospital stay was 2.5 days (range 1-17). Mortality has been zero. Major complications included: 16 slippages (after a range of 6-45 months), 5 outlet obstructions (immediately after the operation), and one intragastric migration (after 2 years). Minor complications included 18 port problems. Since the introduction of gastric fundus fixation to the diaphragm in 2002, gastric slippage has decreased from 8% to 0.9%. BMI has decreased from 44.8 to 32 kg/m(2) at 60 months.
  
  
  CONCLUSIONS
  The technique herein presented is effective and useful to prevent postoperative gastric slippage. It does not induce pseudo-achalasia, if strictly controlled. In fact, it is avoided by the patient due to the immediate appearance of dysphagia, in the case of wrong food ingestion. Long-term clinico-radiological follow-up confirms that the technique is safe and effective in motivated patients with good compliance and willing to undergo periodic studies.
authors.affiliation: Chirurgia B, Ospedale Maggiore, Bologna, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Boschi
authors.forename: Luciano
authors.initials: L
authors.lastname: Fogli
authors.forename: Rossana Daniela
authors.initials: RD
authors.lastname: Berta
authors.forename: Patrizio
authors.initials: P
authors.lastname: Patrizi
authors.forename: Marco
authors.initials: M
authors.lastname: Di Domenico
authors.forename: Fernando
authors.initials: F
authors.lastname: Vetere
authors.forename: Daniele
authors.initials: D
authors.lastname: Capizzi
authors.forename: Francesco Domenico
authors.initials: FD
authors.lastname: Capizzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000517:prevention & control; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome