title: Predicting outcomes of intermediate term complications and revisional surgery following laparoscopic adjustable gastric banding: utility of the CORE classification and Melbourne motility criteria.
abstract: BACKGROUND
  Patients with laparoscopic adjustable gastric bands (LAGB) present at times with adverse symptoms or unsatisfactory weight loss, where a liquid contrast swallow or upper gastrointestinal endoscopy is not diagnostic. Stress barium and high resolution manometry are promising investigations, however, have not yet been established as clinically useful.
  
  
  METHODS
  Patients with an unsatisfactory outcome following LAGB, where liquid contrast swallow and endoscopy were not diagnostic, were evaluated using high resolution video manometry and a stress barium. Pre-operative and follow-up clinical data were collected. Esophageal motility was assessed using the Melbourne criteria.
  
  
  RESULTS
  There were 143 participants in the study. Stress barium identified the following appearances: gastric enlargement (n = 57), transhiatal enlargement (n = 44), pan-esophageal dilatation (n = 9), and anatomically normal (n = 33). Twenty-four (72%) of the anatomically normal patients had deficient esophageal motility. Revisional LAGB surgery was performed in 56 patients. This was successful in gastric enlargements when motility was intact (percentage of excess weight loss (%EWL) 58.3 ± 16.2 vs. 35.4 ± 19.7, p = 0.002). Revisional surgery for transhiatal enlargements improved symptoms but did not improve poor weight loss (%EWL 20.6 ± 24.9 vs. 17.2 ± 25, p = 0.1).
  
  
  CONCLUSIONS
  The CORE classification combines anatomical change with esophageal motility and has been defined for intermediate term complications following LAGB where conventional investigations have not been diagnostic. Revisional LAGB surgery is helpful for patients with a gastric enlargement above the LAGB if esophageal motility is intact. If motility is deficient or there is an esophageal anatomical abnormality, intervention is not likely to remedy poor weight loss.
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Hospital, Commercial Rd Prahran 3181, Melbourne, Australia. paul.burton@med.monash.edu.au
authors.forename: Paul Robert
authors.initials: PR
authors.lastname: Burton
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
authors.forename: Cheryl
authors.initials: C
authors.lastname: Laurie
authors.forename: Geoff
authors.initials: G
authors.lastname: Hebbard
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D001466:Barium Sulfate; D005769:Gastrointestinal Motility; D015391:Gastroplasty / Q000009:adverse effects*; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001466:Barium Sulfate
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