title: Early results of recently introduced laparoscopic adjustable gastric banding procedure for morbid obesity in Croatia.
abstract: BACKGROUND
  Morbid obesity is a growing medical problem that has become of epidemic proportions. Various dietary and pharmaceutical approaches do not obtain acceptable long-term results. Surgery, however, especially gastric restriction, represents a viable therapeutic solution. Individuals with a body mass index (BMI) >40 kg/m2 or >35 kg/m2 with at least one severe comorbidity are considered morbidly obese and generally qualify for weightloss surgery. Laparoscopic adjustable gastric banding (LAGB) is currently the most commonly performed procedure, because it is minimally invasive, does not cause metabolic complications, is completely reversible, and is adjustable. In Croatia, the first LAGB was performed in May 2004 at Clinical Hospital "Sestre Milosrdnice." The aim of this report is to illustrate a newly performed surgical treatment and its results for morbid obesity in Croatia.
  
  
  METHODS
  Within a 12-month period, the adjustable gastric band was implanted in 15 morbidly obese patients (female, 8; male, 7; mean age, 46.67 years; range, 26-59 years). The so-called "pars flaccida" technique was used.
  
  
  RESULTS
  One operation required conversion to laparotomy due to a gastric lesion, and 1 laparoscopy operation was terminated due to massive postoperative adhesions. The average duration of surgery was 90+/-30 minutes. Mean length of stay was 4.9 days (range, 3-9). An average BMI at the time of surgery was 52.21 kg/m2 (range, 45.29 to 61.59; mean body weight was 155.58 kg (range, 127 to 204). Throughout 1-, 3-, 6-, 9-, and 12-month follow-ups, an average of 18.71%, 25.06%, 34.37%, 41.23%, and 47.32% of excessive weight loss (EWL) was observed. Good tolerance and a low complication rate were noted.
  
  
  CONCLUSIONS
  LAGB resulted in good early results and a low complication rate. LAGB appears to be a quality surgical procedure for the management of morbid obesity.
authors.affiliation: Division of General Surgery, General Hospital Cakovec, Cakovec, Croatia. tomislav.novinscak@ck.htnet.hr
authors.forename: T
authors.initials: T
authors.lastname: Novinscak
authors.forename: B D
authors.initials: BD
authors.lastname: Franjic
authors.forename: E
authors.initials: E
authors.lastname: Glavan
authors.forename: M
authors.initials: M
authors.lastname: Bekavac-Beslin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D017523:Croatia; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome