title: Reducing complications with improving gastric band design.
abstract: BACKGROUND
  Adjustable gastric bands have undergone significant design changes since their introduction. Band diameter, balloon volume, and shape have been modified to create high balloon fill volumes but lower and more evenly distributed pressure on the upper stomach. There have been few comparative studies on complication rates with different band types.
  
  
  OBJECTIVE
  To compare complication rates among different types of adjustable gastric bands at a single institution.
  
  
  METHODS
  University-affiliated hospital, United States.
  
  
  METHODS
  We performed a retrospective cohort study of adult patients with a body mass index ≥ 35.0 kg/m(2) who underwent laparoscopic adjustable gastric banding from January 1, 2001 to December 31, 2007 and were followed for at least 5 years. Primary outcomes of the analysis were complications requiring operative management at our institution within the first 5 years after initial band placement. Reoperative procedures included diagnostic laparoscopy, hiatal hernia repair, band repositioning, replacing the band, removing the band, and converting to another bariatric procedure.
  
  
  RESULTS
  For this study, 2711 patients met the inclusion criteria-1827 (67.4%) women and 884 (32.6%) men. Bands initially implanted included first-generation bands, LAP-BAND™ 9.75 cm (24.0%), 10 cm (33.9%) and Vanguard (24.8%) and second-generation bands, AP standard (9.5%) and AP large (7.9%). Four hundred and eighty-five patients experienced complications requiring reoperation. The 5-year follow-up rate was 63.3%. In the first 5 postoperative years there were significantly fewer complications with second-generation bands (10.0% versus 19.5%, P<.0001). Smaller, older bands had the highest complication rates (LAP-BAND 9.75 cm, 28.2%) and complication rates decreased with each successive model. Rates of band removal were not different between first- and second-generation bands. The rate of multiple complications was low at 1.5%.
  
  
  CONCLUSIONS
  First-generation bands are associated with higher complication rates. Our study found that complication rates decreased with each successive model. We can expect that future design modifications will continue improve the performance with the adjustable gastric band.
authors.affiliation: New York University School of Medicine, New York, New York. Electronic address: melissa.beitner@nyumc.org.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Beitner
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Ren-Fielding
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: George A
authors.initials: GA
authors.lastname: Fielding
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
keywords: band type; comparison; laparoscopic adjustable gastric banding