title: Surgeon-performed fluoroscopy conducted simultaneously during all laparoscopic adjustable gastric band adjustments results in significant alterations in clinical decisions.
abstract: BACKGROUND
  Little data exists regarding filling regimens for laparoscopic adjustable gastric bands (LAGB). In addition to patient symptoms and weight changes, we have instituted surgeon-performed, real-time fluoroscopic evaluation in our clinical decision making during all band adjustments.
  
  
  OBJECTIVE
  Our hypothesis is that surgeon-performed, real-time contrast fluoroscopy conducted routinely during all LAGB adjustment results in significant deviations in clinical care.
  
  
  METHODS
  The study is set at the Academic Referral Center, United States
  
  
  METHODS
  Fifty-two consecutive patients who underwent LAGB and presented for adjustment were given a questionnaire evaluating obstructive symptoms. The patient's weight loss history was also reviewed. Each patient underwent real-time fluoroscopy performed by the surgeon during adjustment. Data were recorded and compared to final decision to fill, make no adjustment, or remove fluid.
  
  
  RESULTS
  Patients were, on average, at post-operative visit 5. Sixty-three percent of patients received a fill, 31% had no change, and 6% had fluid removed. On the questionnaire, 15% of patients noted reflux, 10% had dysphagia, and 8% had regurgitation. Eighty percent of patients requested a fill. Thirty-one percent had an abnormality noted on fluoroscopy. Fifteen percent of patients demonstrated esophageal dilation, 15% had a delay of greater than 5 s, 19% had reflux of contrast. Three patients had band displacements on imaging. Additionally, six patients (12%) were not filled based on fluoroscopic findings alone, not predicted by either the survey or historical weight loss.
  
  
  CONCLUSIONS
  Surgeon-performed, real-time, fluoroscopy during LAGB adjustment results in significant changes in clinical care that are not predicted by history and weight loss alone. Routine fluoroscopic imaging altered the course of management in 12% of patients and identified three asymptomatic displaced bands.
authors.affiliation: Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, OH, USA. krohm@ccf.org
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Stacy
authors.initials: S
authors.lastname: Brethauer
authors.forename: Nancy
authors.initials: N
authors.lastname: Duelley
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Philip
authors.initials: P
authors.lastname: Schauer
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
mesh_terms: D015992:Body Mass Index; D003657:Decision Making; D004935:Esophageal Diseases / Q000453:epidemiology; D005260:Female; D005471:Fluoroscopy; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss