Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients.
OBJECTIVE
Retrospective multicenter analysis of the results of two different approaches for band positioning: perigastric and pars flaccida.


METHODS
Data were collected from the database of the Italian Group for LapBand (GILB). Patients operated from January 2001 to December 2004 were selected according to criteria of case-control studies to compare two different band positioning techniques: perigastric (PG group) and pars flaccida (PF group). Demographics, laparotomic conversion, postoperative complications, and weight loss parameters were considered. Data are expressed as mean +/- standard deviation.


RESULTS
2,549 patients underwent the LapBand System procedure [age: 40 +/- 11.7 years; sex: 2,130 female, 419 male; body mass index (BMI): 46.4 +/- 6.9 kg/m(2); excess weight (EW): 60.1 +/- 23.6 kg; %EW: 90.1 +/- 32.4]. During this period 1,343/2,549 (52.7%) were operated via the pars flaccida (PF group) and 1,206/2,549 (47.3%) via the perigastric approach (PG group). Demographics for both groups were similar. Thirty-day mortality was absent in both groups. Operative time was significantly longer in the PG group (80 +/- 20 min versus 60 +/- 40 min; p < 0.05). Hospital stay was similar in the two groups (2 +/- 2 days). Laparotomic conversion was significantly higher in the PG group (6 versus 2 patients; p < 0.001). Overall postoperative complication rate was 172/2,549 (6.7%) and was linked to gastric pouch dilation/slippage (67/172), intragastric migration/erosion (17/172), and tube/port failure (88/172). Gastric pouch dilation and intragastric migration were significantly more frequent in the PG group: 47 versus 20 (p < 0.001) and 12 versus 5 (p < 0.001), respectively. Patients eligible for minimum 3-year follow-up were 1,118/1,206 (PG group) and 1,079/1,343 (PF group). Mean BMI was 33.8 +/- 12.1 kg/m(2) (PG group) and 32.4 +/- 11.7 kg/m(2) (PF group) (p = ns), and mean percentage excess weight loss (%EWL) was 47.2 +/- 25.4 and 48.9 +/- 13.2 in PG and PF groups, respectively (p = ns).


CONCLUSIONS
Significant improvement in LapBand System results with regard to laparotomic conversion and postoperative complication rate, with similar weight loss results, was observed in the pars flaccida group.
Di Lorenzo
Nicola
N
Italian Group for LapBand, Città della Scienza, Naples, Italy.
Furbetta
Francesco
F
Favretti
Franco
F
Segato
Giovanni
G
De Luca
Maurizio
M
Micheletto
Giancarlo
G
Zappa
Marco
M
De Meis
Paolo
P
Lattuada
Ezio
E
Paganelli
Michele
M
Lucchese
Marcello
M
Basso
Nicola
N
Capizzi
Francesco D
FD
Di Cosmo
Leonardo
L
Mancuso
Vincenzo
V
Civitelli
Simona
S
Gardinazzi
Angelo
A
Giardiello
Cristiano
C
Veneziani
Augusto
A
Boni
Marcello
M
Borrelli
Vincenzo
V
Schettino
Angelo
A
Forestieri
Pietro
P
Pilone
Vincenzo
V
Camperchioli
Ida
I
Lorenzo
Michele
M
D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome