Is it possible to improve long-term results of laparoscopic adjustable gastric banding with appropriate patient selection?

INTRODUCTION: The gastric band is still offered as a good bariatric option for highly motivated and carefully selected patients. The question is whether this faith is justified or not. AIM: To assess long-term clinical outcomes of patients who underwent laparoscopic adjustable gastric banding (LAGB) at a single bariatric center and to examine variables associated with patients' adherence to scheduled postoperative appointments. MATERIAL AND METHODS: A retrospective review of patients who underwent LAGB between 2004 and 2009 was performed. The initial cohort included 167 patients. Data regarding sex, age, preoperative weight, hometown population and distance from the bariatric center, and gastric band volume were collected. Compliance was measured as the number of postoperative appointments. Clinical outcome was defined as percent excess weight loss (%EWL) at the end of the observation period or at band removal. RESULTS: The LAGB was performed in 167 patients between 2004 and 2009. The mean follow-up time was 90 ±24 months. Five (3%) patients were lost to follow-up; 37 (22.2%) had their band removed. The remaining 125 (74.8%) patients retained their bands and were included in the analysis. The mean %EWL was 33.0 ±26.6%. Thirty-one (18.6%) patients achieved %EWL > 50%. CONCLUSIONS: This study found that LAGB was not an effective bariatric procedure in long-term observation. Only 25% of 125 patients who maintained a functioning band achieved %EWL > 50%. Compliance was the only independent prognostic factor for weight loss. Other factors had no influence on outcome.

Study of the prevalence of gastroesophageal reflux symptoms and the role of each in relation to the GERD Impact Scale, based on a population of patients admitted for laparoscopic surgery compared to a control group.

INTRODUCTION: Gastroesophageal reflux disease (GERD), demonstrated to impair quality of life (QoL), appears to show significant variation in its prevalence. Estimation of the prevalence is difficult. When defined as at least weekly heartburn and/or acid regurgitation, the prevalence reported in Asia is 2.5-27.6%, in Europe 23.7% and in the US 28.8%. AIM: The study evaluates the prevalence of GERD symptoms in the assessment of the GERD Impact Scale (GERD-IS) in two age groups of patients. MATERIAL AND METHODS: Evaluation of the prevalence of GERD symptoms with the GERD Impact Scale survey in two groups of patients: younger and older. A total of 2,649 surveys were rated. Statistical analysis was performed using the data analysis software system Statistica version 10.0 and Microsoft Excel. RESULTS: According to this study the symptoms of GERD included in GERD-IS in northern Poland vary from 0.9-2.4% as daily sensations to 18.9-40.5% occurring sometimes. Individuals with hiatal hernia (HH) were significantly older than those without HH. HH was significantly more frequent in males than females. CONCLUSIONS: Estimation of the prevalence of GERD is difficult, because the medications are widely available and people use them without any consultation. They do not recognize the symptoms as a disease whose treatment can also be surgical. Our analysis shows that the prevalence of symptoms of GERD in northern Poland is as high as 5%. Hence further investigation should be performed and people's awareness should be raised.

Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy.

INTRODUCTION: Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. AIM: To develop and implement certain standards for early detection of complications. MATERIAL AND METHODS: The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD). RESULTS: Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder. CONCLUSIONS: The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

The usefulness of biliopancreatic diversion/Scopinaro operation in treatment of patients with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is the most common form of obesity with a genetic basis. The short expected survival time due to numerous accompanying diseases and their complications is the reason for research on the maximally efficient method of treatment of obesity in this syndrome. Undertaken attempts of conservative treatment, for example with somatostatin, are ineffective. It seems that the only effective treatment of obesity in this syndrome may be surgical. In this article we present 2 cases of patients with PWS who underwent surgery consisting of biliopancreatic diversion (BPD)/Scopinaro procedure. The BPD/Scopinaro operation in selected cases of disciplined patients with a co-operative family, which we find of key importance, can be considered as one option of treatment of this syndrome in patients with prior neglect of conservative treatment.

Band misplacement: a rare complication of laparoscopic adjustable gastric banding.

INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) is considered to be a very effective minimally invasive procedure for treating morbidly obese patients. Nevertheless, there are numerous complications that a good surgeon should be aware of. Most of them have been widely presented in the literature. AIM: In this study we would like to focus on the rare but important complication which is ante-gastric positioning of the band. MATERIAL AND METHODS: Between January 2005 and May 2008, 122 patients (88 female and 34 male) with mean body mass index (BMI) of 48.5 kg/m(2) (range 35-80 kg/m(2)) underwent LAGB procedure. The average time of hospitalization was 2.47 days. The first radiological control with band calibration was performed 6 weeks after the operation. Consecutive follow-up depended on the percent excess weight loss (EWL%). RESULTS: Of the 122 patients, 4 (3.3%) presented herein had a band misplaced in the ante-gastric position. There were three out of five surgeons who faced complications of this type. The most and the least experienced team members avoided misplacing the band. Two physicians encountered it at the beginning of their learning curve, and for one it was not related to the process of education. Among other postoperative complications there were two incidents of band slippage, 2 patients had their port localization corrected and in one case drain disconnection occurred. There were no mortalities. CONCLUSIONS: Ante-gastric positioning of the band was the most common cause of obesity surgery failure in our group of patients. It was very difficult to recognize during the typical postoperative checkups; hence there arose a question whether it has been disregarded in other studies.

Transumbilical laparoendoscopic single-site total mesorectal excision for rectal carcinoma.

In recent years, multiple studies have proved laparoscopic total mesorectal excision (TME) to be as safe and as effective in rectal cancer treatment as open surgery, with the undeniable benefit of perioperative trauma reduction. Decreasing the number of incisions and performing single-port surgery could have further reduced the trauma. A new access device, QuadPort™ Olympus, enables operations from just one small transumbilical incision, leaving a barely visible scar afterwards. This is one of the first reports of transumbilical laparoendoscopic single-site TME for rectal carcinoma. A 73-year-old woman presented with tubulo-villous adenoma with high-grade dysplasia and focal adenocarcinoma in situ at 7 cm from the anal verge. She had TME performed via a QuadPort™, Olympus, in line with principles of laparoscopic TME. The operating time was 80 min. There were no adverse events during the procedure. Total blood loss was less than 100 ml. There were no complications in the postoperative period. The patient required only non-opioid analgesia, during the first 2 days. The patient was discharged on the 3(rd) postoperative day with standard recommendations. Feasibility and safety of the proposed transumbilical laparoendoscopic single site TME for rectal carcinoma was proved. It is a technically demanding procedure, requiring appropriate laparoscopic skills. The QuadPort provided good oncological protection of the wound and easy specimen extraction. Reduced operative trauma resulted in no opioid administration in the perioperative period. Hospital stay was comparable with laparoscopic TME but the cosmetic effect was much better.

The first report on hybrid NOTES adjustable gastric banding in human.

BACKGROUND: Despite their current limitations, metabolic surgery and natural orifice transluminal endoscopic surgery (NOTES), set new horizons. In this article, the first three cases of adjustable gastric banding (AGB) through transvaginal access in obese women are described. METHODS: In the General and Vascular Surgery Department, Ceynowa Hospital, Poland, three cases of AGB through the transvaginal access in hybrid, laparoscopically assisted NOTES technique were performed. All patients were female with BMI range 35-37. A dual-channel endoscope and regular laparoscopic instruments were used. RESULTS: The mean operating time was 110 min. Indometacin was given intravenously PRN for postoperative pain. None of the patients required more than 3 g of indometacin and for longer than 24 h postoperatively. None required opioids either. There was one major complication of iatrogenic damage to the ureter, which required subsequent hospitalisation and laparoscopic repair. Hospitalisation time was 2 days. During 2 months follow up, the mean weight loss was 15 kg. There were no malpositions of the band. There was no early mortality in the study group. CONCLUSION: Feasibility of the proposed hybrid laparoscopically assisted NOTES adjustable gastric banding was proved. It is a technically demanding procedure, requiring appropriate endoscopic and laparoscopic skills. To avoid ureteric damage one should acquire safe colpotomy skills before commencing transvaginal NOTES operations.