title: Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients.
abstract: 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.
authors.affiliation: Italian Group for LapBand, Città della Scienza, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Furbetta
authors.forename: Franco
authors.initials: F
authors.lastname: Favretti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Segato
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Luca
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Micheletto
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Paolo
authors.initials: P
authors.lastname: De Meis
authors.forename: Ezio
authors.initials: E
authors.lastname: Lattuada
authors.forename: Michele
authors.initials: M
authors.lastname: Paganelli
authors.forename: Marcello
authors.initials: M
authors.lastname: Lucchese
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
authors.forename: Francesco D
authors.initials: FD
authors.lastname: Capizzi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Di Cosmo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mancuso
authors.forename: Simona
authors.initials: S
authors.lastname: Civitelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Gardinazzi
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giardiello
authors.forename: Augusto
authors.initials: A
authors.lastname: Veneziani
authors.forename: Marcello
authors.initials: M
authors.lastname: Boni
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Borrelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Schettino
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pilone
authors.forename: Ida
authors.initials: I
authors.lastname: Camperchioli
authors.forename: Michele
authors.initials: M
authors.lastname: Lorenzo
mesh_terms: 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