Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity.
BACKGROUND
The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss.


METHODS
Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up.


RESULTS
There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases.


CONCLUSIONS
Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
Pomerri
Fabio
F
Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. fabio.pomerri@unipd.it.|The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy. fabio.pomerri@unipd.it.
Foletto
Mirto
M
2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Bernante
Paolo
P
2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Tonello
Elisa
E
Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Muzzio
Pier Carlo
PC
Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.|The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D013270:Stomach / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult