title: Does adding a lesser-curvature gastrogastric plication suture reduce the need for revision after laparoscopic adjustable gastric band placement?
abstract: BACKGROUND
  The need for revision after laparoscopic adjustable gastric band (LAGB) surgery has been reduced over the past 10 years with the introduction of the pars flaccida technique, delicate band tightening, and concurrent hiatal hernia repairs. However, band revision still occurs for as many as 5% of patients. Placement of a lesser-curvature gastrogastric suture distal to the band is one newer technique suggested to lower band slippage. To evaluate the worth of this technique, the authors have investigated two groups of patients in their practice: one group with the plication stitch and one group without it.
  
  
  METHODS
  This retrospective review examined data for 1,365 LAGB patients collected prospectively by an institutional review board-approved database between July 2007 and May 2010. One surgeon did not perform the plication stitch (n = 776) and one did (n = 589). The surgical techniques were very similar. The majority of the patients had crural repair at the primary operation. Band revision rates were assessed.
  
  
  RESULTS
  For 1,365 patients, LAGB was performed safely. The mean follow-up period was 22 months. The two groups were similar. The no-stitch group consisted of 776 patients (496 women, 64%) with a mean age of 42 years, a mean weight of 278 lb, and a mean body mass index (BMI) of 44.6 kg/m(2). The stitch group consisted of 589 patients (426 woman, 72%) with a mean age of 40 years, a mean weight of 278 lb, and a mean BMI of 44.8 kg/m(2). The no-stitch group had an estimated weight loss (EWL) of 44% at 12 months and 50% EWL at 2 years. The stitch group had 37% EWL at 12 months and 45% EWL at 2 years. Both groups had very low revision rates. The no-stitch group had 4 revisions in 776 patients (0.26%), and the stitch group had 9 revisions in 589 patients (1.5%).
  
  
  CONCLUSIONS
  Adding gastrogastric plication sutures offers no benefit of reducing the rate of revision after LAGB surgery.
authors.affiliation: New York University Langone Medical Center, 530 First Avenue, Suite 10-S, New York, NY 10016, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zagzag
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Schwack
authors.forename: Heekoung
authors.initials: H
authors.lastname: Youn
authors.forename: Christine Ren
authors.initials: CR
authors.lastname: Fielding
authors.forename: George A
authors.initials: GA
authors.lastname: Fielding
authors.forename: Marina S
authors.initials: MS
authors.lastname: Kurian
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013536:Suture Techniques; D015431:Weight Loss