Laparoscopic adjustable gastric banding in an ambulatory surgery center.
BACKGROUND
In the management of morbid obesity by laparoscopic adjustable gastric banding (LAGB), careful patient preparation and attentive follow-up have been shown to produce the best long-term results.


METHODS
Between November 2002 and August 2007, prospective data were collected on 2,411 consecutive patients, 84% of whom underwent LAGB at our freestanding outpatient surgery center, staffed by our dedicated multidisciplinary bariatric team. Outcomes reported include changes in mean body mass index (BMI), percentage excess body weight loss (%EBWL), and incidence of complications at 1 year, as well as the slippage rate up to 3 years.


RESULTS
A total of 2,003 (83%) female and 409 (17%) male patients with a mean age of 44.1 years (range 15-76 yrs) and a BMI (mean +/- SD) of 45.7 +/- 7.9 kg/m2 (range 29.1-83.1 kg/m2) underwent LAGB. In 2,027 patients (84%), LAGB was performed as an outpatient procedure, with 1 (0.04%), conversion from a laparoscopic to an open procedure. The majority of operations were completed in less than 1 hour, using the pars flaccida technique. One-year weight loss data were available in 1,144 patients (47%). BMI decreased to 36.9 +/- 7.4 kg/m2 (-8.8). Mean %EBWL at 1 year (+/- 60 days) was 41.0% +/- 18.1% (range 0.7%-113.9%). Complications occurred in 241 of 2,411 (10%) patients. There was 1 death (0.04%). Cumulative slippage at 1, 2, and 3 years, respectively, was 0.4%, 2.4%, and 10%. There were 56 (2.3%) port-related problems, and 13 band explantations (0.54%).


CONCLUSIONS
With extensive staff experience and patient preparation, LAGB can be performed safely as an outpatient procedure for select patients. Close follow-up is crucial in order to optimize LAGB outcomes for the long term.
Watkins
Brad M
BM
Synchrony Health, Northwest Weight Loss Surgery, Everett, WA 98203, USA. Brad.Watkins@synchronyhealth.com
Ahroni
Jessie H
JH
Michaelson
Robert
R
Montgomery
Kevin F
KF
Abrams
Ron E
RE
Erlitz
Marc D
MD
Scurlock
Jim E
JE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D010045:Outpatients / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss