Nonsurgical management of luminal dilatation after laparoscopic adjustable gastric banding.
BACKGROUND
Proximal luminal dilatation (PLD) is one of the most significant challenges following laparoscopic adjustable gastric banding (LAGB). If PLD is identified at an early stage, there is potential to avoid reoperation or irreversible change by implementing nonsurgical measures. The success of these strategies is unknown. The aim of this study was to determine the outcome of how often PLD can be successfully treated nonsurgically.


METHODS
The records of patients who underwent primary LAGB insertion by a single surgeon from January 2005 to December 2006 were reviewed. Study participants were all patients who had subsequently undergone a postoperative liquid contrast swallow demonstrating a PLD. The severity of PLD, subsequent management, and outcomes were recorded and assessed.


RESULTS
There were 354 patients who underwent a primary LAGB insertion during the study period. Seventy-eight patients were found to have varying degrees of PLD and had an attempt at nonsurgical management. Thirty-four of these patients (43.6 %) were successfully managed nonsurgically at a mean follow-up of 2.8 years (33.2 months, CL ± 3.2). The success with nonsurgical management was lower if the symmetrical pouch dilatation was more severe or gastric prolapse was seen at presentation, and if no improvement in liquid contrast swallow was seen.


CONCLUSIONS
PLD can often be successfully managed with nonsurgical measures, maintaining good weight loss in the intermediate term. Patients with more significant dilatation are more likely to require revisional surgery. Early recognition may have a role in preventing surgery or more severe abnormalities.
Geraldine
G
Ooi
Paul
P
Burton
Cheryl
C
Laurie
Geoff
G
Hebbard
Paul E
PE
O'Brien
Wendy A
WA
Brown
D000328:Adult; D005260:Female; D013271:Gastric Dilatation / Q000628:therapy*; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015431:Weight Loss