title: Risk of gastric pouch enlargement with adjustable gastric banding in premenopausal women: sex hormones may play a role.
abstract: OBJECTIVE
  To examine the influence of age and gender on the development of proximal gastric pouch distension (PPD) after laparoscopic adjustable gastric banding (LAGB) surgery.
  
  
  BACKGROUND
  PPD is the most common reason for revision with adjustable gastric banding surgery. Maintaining the anatomical integrity of bariatric surgery is a key to long-term success. It is therefore important to understand risk factors for complications.
  
  
  METHODS
  We extracted details of 3000 consecutive individuals who underwent primary LAGB procedures at a single center between February 2005 and May 2011. Contemporaneous details of all complications were recorded in a database. The characteristics of those that subsequently required revision surgery for PPD were assessed and compared with those that did not.
  
  
  RESULTS
  There were 132 cases for PPD requiring surgical intervention before September 2011. Incident PPD occurred in 5.1% and 1.3% of women and men, respectively. The mean age of those with PPD was 39.9 ± 9.25 compared with 43.9 ± 11.0 for those without it. The age and gender effects were independent, and the age effect was restricted to women. The adjusted odds ratios were 0.971 (95% CI [confidence interval], 0.954-0.986, P < 0.001) for age and 0.26 (95% CI, 0.12-0.56, P = 0.001) for male gender and younger women were more likely to have asymmetrical distension.
  
  
  CONCLUSIONS
  Younger women are at higher risk of PPD after LAGB surgery than men and women older than 50 years. Sex hormones may play a role in predisposing to gastric stretch after surgery. These findings may apply more broadly to the gastric "restrictive" component of other bariatric procedures.
authors.affiliation: Vascular & Hypertension Division-Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. john.dixon@bakeridi.edu.au
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Cobourn
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D017697:Premenopause; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014739:Victoria / Q000453:epidemiology
chemical_list: D012739:Gonadal Steroid Hormones