Pulmonary aspiration during anesthetic induction in a patient with laparoscopic adjustable gastric band: A case report

Recently, the number of laparoscopic adjustable gastric banding surgery is increasing as is the number of patients with morbid obesity rapidly. However, no anesthetic management including preoperative fasting strategy for patients with laparoscopic adjustable gastric banding exists. Hereby, we report a case of a 22-year-old woman with laparoscopic adjustable gastric banding who suffered pulmonary aspiration during the anesthetic induction for appendectomy, despite a preoperative fasting period longer than 14 h. This case strongly suggests that guidelines for anesthetic management including the appropriate fasting period for patients with laparoscopic adjustable gastric banding are desperately required.

Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.

Appropriate Time for Gastric Band Removal

As the epidemic of morbid obesity has been rising globally over the decade, bariatric surgery has also been grown to manage obesity and its comorbidities. Besides of its safety, laparoscopic adjustable gastric banding (LAGB) has been known to be more effective in handling obesity with regard to weight loss and its long-term sustainability, compared to medical treatments. Failure of LAGB, defined as either the unsatisfactory weight loss or the development of major long-term complications, results in revision or removal of gastric band. After explantation of gastric band, rebanding or conversion into other bariatric surgeries such as Roux-en-Y gastric bypass or sleeve gastrectomy is required in terms of maintaining weight loss. Major cause of band removal alone is psychogenic factors like patients' anxiety or feeing discomfort without anatomic problems. In Korea there has been grown of patients' vague demand to remove their gastric band regarding the death of a celebrity. Considering such trend, in order to prevent indiscriminate finish of the treatment, suggestion of appropriate time for gastric band removal on the basis of analyzing the course of weight loss and the occurrence of complications is essential.

Conversion Sleeve Gastrectomy for Pouch Dilatation and Band Scar Stenosis: 1 Case

Esophageal and gastric pouch dilatations are common complications that occur after laparoscopic adjustable gastric banding, often performed to treat morbid obesity. Most cases are treated by a gastric band deflation or a removal of band. Nevertheless, additional surgical procedures are rarely ever needed to treat persistent dysphagia and pouch dilatation. We report here, the case of a 38-year-old woman with constant vomiting and severe persistent epigastric pain despite the gastric band deflation, and a band scar stenosis, treated via laparoscopic conversion sleeve gastrectomy. Surgical band scar revision, or revision sleeve gastrectomy, may be considered if gastric pouch dilation and dysphagia are not treated by gastric band deflation.

Comparison between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding for morbid obesity / 国际外科学杂志

Objective To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) on excess weight loss (EWL) and type 2 diabetes mellitus (T2DM),then to evaluate which one is superior to the other.Methods PubMed,Embase,Wanfang Database and HowNet database were searched for publications concerning LAGB and LSG from 2000 to 2012,with the last search on August 17,2012.EWL and T2DM improvement over 6 and 12 months were pooled and compared by meta-analysis.Odds ratios (ORs) and mean differences were calculated with 95％ confidence intervals （ CI).Results Eleven studies involving 1004 patients in total met the inclusion criteria.The mean percentage EWL for LAGB was 33.9％ after 6 months in studies and 37.8％ after 12 months; for LSG,EWL was 50.6％ after 6 months and 51.8％ after 12 months,T2DM was improved in 42 of 68 patients (61.8％) after LAGB and 66 of 80 (82.5％) after LSG.Conclusions LSG is more effective than LAGB in morbid obesity,with higher percentage EWL and greater improvement in T2DM.

Laparoscopic adjustable gastric banding in a multidisciplinary modality for morbid obesity / 中华内分泌外科杂志

Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6％) of pulmonary infection and long-term complications included 2 cases (7.1％)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(％ EWL)at postoperative 24 months was 41.3％.％ EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.

Initial body mass index on weight loss among obese Filipino adults who underwent Laparoscopic Adjustable gastric banding: A cohort study / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To determine the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss and the association between initial body mass index (BMI) and successful weight loss, defined as >50% excess weight loss (EWL) among obese Filipino adults at St. Luke’s Medical Center. @*Methodology@#Data from 97 patients who were at least 18 years old at the time of gastric banding were reviewed retrospectively. Patient follow-up was poor 2 years post-surgery, which precluded analysis of follow-up data beyond 2 years. Changes in weight loss parameters from baseline to the different observation periods were carried out using paired t- test. To determine the association of different factors with success in weight loss, Independent t-test and Chi-square tests were used. A p-value ≤0.05 was considered significant. @*Results@#Majority of the patients were female (61%) and Southeast Asian (77%). Ages ranged from 18 to 68 years. Mean BMI was 44.1 ± 0.1 kg/m2 and mean excess weight was 61.4 ± 26.5 kg. Excess weight loss of 43.84 ± 25.09% and BMI reduction of 21.54 ± 13.39% were attained at 2 years. Lower initial BMI with a mean of 38.12±3.28 kg/m2 was associated with successful weight loss, 1 year after gastric banding (p<0.001). @*Conclusion@#Patients attained 43.84% EWL 2 years after gastric banding. Those with higher initial BMI were less likely to achieve successful weight loss 1 year after gastric banding.

Cirugía Bariátrica / Bariatric surgery

La cirugía de la obesidad ha tenido un impresionante desarrollo en los últimos 20 años, debido a la necesidad de tratamiento efectivo y duradero para esta enfermedad crónica epidémica. La introducción de la técnica laparoscópica a las cirugías bariátricas contribuyó en forma importante a disminuir sus complicaciones y mortalidad. Las operaciones más frecuentes en el mundo son el bypass gástrico, la gastrectomía vertical, la banda gástrica ajustable y la derivación biliopancreática, aunque en la actualidad en nuestro país se utilizan solo las dos primeras. Se describen estas cirugías bariátricas, su técnica, complicaciones y resultados. El tratamiento quirúrgico de la obesidad logra bajas de peso y control de las comorbilidades muy superiores a las logradas por el tratamiento médico y terapia farmacológica. Por ello, el tratamiento quirúrgico es la terapia estándar para pacientes con obesidad.

Obesity surgery has had an impressive development in the last 20 years, due to the need for effective and lasting treatment for this epidemic cronic disease. The introduction of laparoscopic technique in bariatric surgical interventions contributed significantly on reducing surgical complications and mortality. The most common operations in the world are gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, though only the first two mentioned are used in our country today. These bariatric surgery, their technique, complications and results are described. Surgical treatment of obesity achieves weight loss and comorbidities control far superior to those achieved by medical treatment and pharmacologic therapy. Therefore, surgical treatment is the standard therapy for obese patients.

Simultaneous Laparoscopic Band Removal and Sleeve Gastrectomy: Case Report and Review of Literature

More attention has been paid to bariatric surgery due to an increase in the obese population in Korea. Laparoscopic adjustable gastric banding (LAGB) is the most popular procedure for weight-loss but the complication rate may increase with time. Revision surgery is needed if there are complications or the weight is regained after LAGB, and a laparoscopic sleeve gastrectomy could be performed in the case of band failure. Successful band removal and sleeve gastrectomy wereperformed simultaneously without complications.

The Impact of Metabolic and Bariatric Surgery on Morbidly Obese Patients with Type 2 DM

PURPOSE: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are the most effective intervention and cure in achieving sustained weight loss in the morbidly obese with co-morbities, especially in type 2 diabetes mellitus (DM). Currently, there are few data in the literature presenting early diabetic outcomes between the 2 major bariatric surgeries in Korea. The aim of this study is to observe weight loss, improvement of type 2 DM after LRYGB and LAGB. METHODS: 33 retrospective data were obtained from diabetic subjects undergoing LRYGB (n=53) and LAGB (n=77). These measurements included age, sex, body mass index (BMI), pre-operative diabetic duration, post-operative diabetic at follow-up visit after surgery. Paired t-test, and SPSS12.0 were used for statistical analysis. RESULTS: 33 morbidly obese patients with type 2 DM who had both procedures complain of general weakness. Most patients were taking oral medications or insulin and tired of them. Pre and post-op 12 months of percent of excess weight loss (%EWL), fetal bovine serum (FBS), hemoglobin A1c (HbA1C) presented at 0%, 185.6 mg/dl, 8.7% and 70.6%, 123.4 mg/dl, 6.6% in patients who had LRYGB (P<0.05). Pre and post-op 12 months of %EWL, FBS, HbA1C presented at 0%, 180.6 mg/dl, 8.4% and 32.8%, 136.5 mg/dl, 6.8% in patients who had LAGB (P<0.05). Rate of discontinuance or decreasing for treatment of type 2 DM after surgery showed 94% for LRYGB versus 80% for LAGB, and unchanged rates were 6% versus 20%, respectively. CONCLUSION: This study showed LRYGB and LAGB are quite satisfactory and promising bariatric procedures with significant weight loss and improvement of type 2 DM in Koreans. LRYGB is significantly associated with more weight loss, more diabetic outcome than LAGB. Clinical experiences in Korea with both procedures are limited and a larger number of cases are need, but the recent data shows promising results that are comparable to the international experience.

Band Slippage after Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) has proved to be safe and effective, worldwide. The perigastric technique was once the most frequent method of band placement, but posterior prolapse was a problem. The introduction of the pars flaccida technique has considerably reduced the incidence of this complication, and, currently, this technique is the most utilized method and recommended by most bariatric surgeons. However, LAGB with pars flaccida technique has rare complications such as band slippage and gastric pouch dilatation in 2~5% of patients. We have experienced 2 band replacement cases for band slippage and pouch dilatation each happening about 1 and 2 years after LAGB.

Initial Experience with Bariatric Surgery in Korea: 120 Cases (LRYGB and LAGB) / 대한내시경복강경외과학회지

PURPOSE: Obesity has become a global epidemic disease, and bariatric surgery is now being increasingly performed in Korea as well as in western countries. Bariatric surgery has been performed in Korea since 2003. However, there is no data on cases of Korean bariatric surgery regarding the weight loss as well as the factors associated with the surgical outcome. METHODS: 120 total cases of bariatric surgery [LRYGB=48, LAGB=72] were done at St. Mary's Hospital. We retrospectively reviewed the series of bariatric cases and we analyzed the surgical outcome, the complications and the clinical factors associated with the surgical outcomes. RESULTS: There were no significant differences in age, BMI and pre-existing comorbidities for both procedures. The percentage of excess weight loss (%EWL) of the LRYGB at 6, 12 and 24 months was 63.8%, 73.7% and 87.5%, respectively, and the %EWL of the LAGB was 33.4%, 44.7% and 43.8%, respectively. Factors such age and gender were not associated with the surgical outcome. Yet the initial BMI tended to affect the surgical outcome. CONCLUSION: The results of our study indicate that LRYGB and LAGB are technically feasible and safe procedures. Both are quite satisfactory and promising procedures for loosing a significant amount of weight.