title: Impact of Surgical Technique on Long-term Complication Rate After Laparoscopic Adjustable Gastric Banding (LAGB): Results of a Single-blinded Randomized Controlled trial (ANOSEAN Study).
abstract: OBJECTIVE
  The aim of the study was to explore the impact of the absence of band fixation on the reoperation rate and to identify other risk factors for long-term complications.
  
  
  BACKGROUND
  Laparoscopic adjustable gastric banding has been demonstrated to permit important weight loss and comorbidity improvement, but some bands will have to be removed mainly for failure or in case of planned 2-step surgery. Then, the absence of a gastro-gastric suture (GGS) would allow easier band removal. There are insufficient data to conclude that GGS should be abandoned, as the associated risk of band slippage has not been prospectively assessed.
  
  
  METHODS
  The ANOSEAN study was a randomized controlled single-blind trial (CPP 2009-A00346-51). Primary outcome was reintervention rate for band removal or repositioning at 3 years. It included 706 patients in 17 bariatric centers. Patients in group 1 received a gastric band with GGS. Inclusion criteria were adapted from National Institutes of Health recommendations. Surgical technique was standardized among all surgeons.
  
  
  RESULTS
  At 3 years, the reintervention rate for band retrieval or repositioning was significantly higher in the absence of band fixation (19.4% vs11.3%; P = 0.013), partly because of the slippage rate (10.3% vs 3.6%; P = 0.005). Body mass index <40 kg/m at baseline was also an independent risk factor of slippage (odds ratio 2.769, 95% confidence interval 1.373, 5.581).
  
  
  CONCLUSIONS
  GGS prevents band slippage and lower reintervention rate at 3 years. Fixation could be discussed for patients with high BMI who are scheduled to undergo 2-step surgery, but it needs to be specifically assessed.
authors.affiliation: *General and Endocrine Surgery, Lille University Hospital, Lille, France†Bariatric and Visceral Surgery, Clinique de la Sauvegarde, Lyon, France‡Endocrine and Metabolic Surgery, Marseille University Hospital, France§Bariatric and Visceral Surgery, Clinique de Saint-Omer, Saint-Omer, France¶Bariatric and Visceral Surgery, Arras Hospital, Arras, France||Bariatric and Visceral Surgery, Douai Hospital, Douai, France**Bariatric and Visceral Surgery, Boulogne-sur-Mer Hospital, Boulogne-sur-Mer, France††Bariatric and Visceral Surgery, Clinique de la Victoire, Tourcoing, France‡‡Bariatric and Visceral Surgery, Clinique de la Louvière, Lille, France§§Bariatric and Visceral Surgery, Valenciennes Hospital, Valenciennes, France¶¶Inserm U 1190, European Genomic Institute for Diabetes, Lille University, Lille, France||||Department of biostatistics, Lille University Hospital, Lille, France***King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Le Coq
authors.forename: Vincent
authors.initials: V
authors.lastname: Frering
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ghunaim
authors.forename: Pierre
authors.initials: P
authors.lastname: Campan
authors.forename: André
authors.initials: A
authors.lastname: Dabrowski
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mulliez
authors.forename: Eric
authors.initials: E
authors.lastname: Loridan
authors.forename: Frédéric
authors.initials: F
authors.lastname: Combemale
authors.forename: Franck
authors.initials: F
authors.lastname: Denimal
authors.forename: Fanelly
authors.initials: F
authors.lastname: Torres
authors.forename: Gregory
authors.initials: G
authors.lastname: Baud
authors.forename: Camille
authors.initials: C
authors.lastname: Thibault
authors.forename: Guelareh
authors.initials: G
authors.lastname: Dezfoulian
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnalsteen
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.forename: Robert
authors.initials: R
authors.lastname: Caiazzo
mesh_terms: D000328:Adult; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D016037:Single-Blind Method; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome