Disappointing results with a 5 cm calibrating device for laparoscopic vertical banded gastroplasty.
BACKGROUND
The gastric outlet represents a critical point of laparoscopic vertical banded gastroplasty (LVBG): the diameter and the material used to calibrate the gastric outlet are essential for long-term success. We present the results of our initial clinical experience with the Proring band, a new calibrating device specifically designed to calibrate LVBG outlet.


METHODS
Between February and April 2004, 13 LVBG were performed using the Proring band. There were 12 women and one man; their mean age was 44 years; mean preoperative weight was 118.8 kg; mean body mass index (BMI) was 44.4 kg/m(2).


RESULTS
The immediate postoperative course was uneventful in all cases. In the follow-up 10 patients out of 13 (76.9%) presented a sudden or progressive food intolerance. Five patients were immediately reoperated by laparoscopic approach and five underwent endoscopic dilatation with initial clinical improvement; early recurrence of symptoms despite further dilatations occurred in four out of five cases. These four patients were then reoperated. Therefore a total of nine (69.2%) patients underwent a laparoscopic reoperation with Proring band removal and its replacement with a polypropylene band. In seven cases an intraoperative endoscopic dilatation was associated with the laparoscopic procedure. Outcome was successful in all cases, with discharge after two days.


CONCLUSIONS
The results of our experience using the Proring band are unsatisfactory, showing 76.9% with outlet stenosis and 69.2% with reoperations. These data compare negatively with our previous experience on more than 900 VBG procedures using polypropylene mesh.
Scozzari
Gitana
G
Chirurgia Generale II e Centro di Chirurgia Mini Invasiva, Department of Surgery, University of Turin, Turin, Italy.
Toppino
Mauro
M
Bonnet
Gisella
G
Morino
Mario
M
D000328:Adult; D015992:Body Mass Index; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000175:diagnosis* / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D016896:Treatment Outcome
Surg Clin North Am. 1992 Apr;72(2):501-13
1549806
Int J Obes Relat Metab Disord. 1995 Sep;19 Suppl 3:S56-60
8581079
Obes Surg. 2002 Dec;12(6):826-30
12568189
Gastroenterol Clin North Am. 1987 Sep;16(3):495-502
3436656
J Chir (Paris). 2003 Feb;140(1):4-21
12709648
Obes Surg. 2002 Feb;12(1):62-4
11868301
Curr Surg. 2003 Jan-Feb;60(1):33-7
14972308
Obes Surg. 1997 Jun;7(3):189-97
9730547
Ann Surg. 2003 Dec;238(6):835-41; discussion 841-2
14631220
Arch Surg. 1998 Feb;133(2):189-93
9484733
Arch Surg. 1982 May;117(5):701-6
7073493
Obes Surg. 1995 Feb;5(1):77-80
10733799
Surg Endosc. 2002 Nov;16(11):1566-72
12063579
Obes Surg. 1997 Aug;7(4):367-8
9730526
Am J Surg. 1990 Nov;160(5):496-500
2240383
Surg Laparosc Endosc. 1996 Apr;6(2):102-7
8680631
Surgery. 1990 Jan;107(1):20-7
2296754
World J Surg. 1998 Sep;22(9):919-24
9717417
Am Surg. 1990 Mar;56(3):167-74
2316938
Arch Surg. 1990 Oct;125(10):1400-3; discussion 1403-4
2222181
Ann Chir. 1996;50(2):139-45
8762264
Br J Surg. 1993 Nov;80(11):1421-3
8252354
Obes Surg. 2002 Oct;12(5):672-8
12448390
Obes Surg. 1995 Aug;5(3):323-326
10733820
Obes Surg. 1999 Feb;9(1):55-6
10065584
Obes Surg. 2002 Aug;12(4):588-91
12194557
Obes Surg. 2000 Feb;10(1):41-6; discussion 47
10715643