Long term efficacy of laparoscopic adjustable gastric banding--retrospective analysis.

BACKGROUND: Laparoscopic procedures have emerged over the past decade for treatment of obesity. Laparoscopic adjustable gastric banding is the easiest surgical technique for morbid obesity. OBJECTIVES: The authors analyzed the long term results of laparoscopic adjustable gastric banding in their center. MATERIAL AND METHODS: A total of 172 consecutive patients who had undergone laparoscopic adjustable gastric banding between May 2005 and February 2011 in authors clinic were contacted for evaluation. The main outcome measures were complications, secondary operations, percent excess weight loss, mortality, patient satisfaction and band removal rate. RESULTS: The follow-up rate was 62.2%. Mean age of patients was 30.6 years. Mean body mass index of patients was 48.47 +/- 7.8 kg/m2. Median follow-up interval was 36 months (min 8, max 81) and band removal rate was 19.1%. There was one mortality. Of all patients, 33 had band removal. The band was removed laparoscopically in 21 patients. The main reason for band removal was slippage followed by band erosion. After band removal, 4 patients had re-banding, 5 had Roux-en-Y gastric bypass. Overall, the mean percent excess weight loss was 50.6 +/- 7.8% (range, 5-100%). Mean percent excess weight loss for those who had band removal was 27.8 +/- 5.78% (range 12.5-34.1%). Overall satisfaction index was rated as "good" for 42% of patients. CONCLUSIONS: Despite a low satisfaction index, considerable mean percent excess weight loss and vast improvement in co-morbidities is achieved after laparoscopic adjustable gastric banding. The authors conclude that laparoscopic adjustable gastric banding can be utilized as the initial surgical procedure in morbid obesity.

Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity.

BACKGROUND: There are differences in the levels of inflammation mediators, lipids, and formed elements of the blood in morbidly obese patients compared with individuals of normal weight. In the current study, the change in these parameters was determined in patients who achieved weight loss by undergoing laparoscopic adjustable gastric banding (LAGB) by comparing preoperative, and early (3 months) and late (12 months) postoperative values. METHODS: The body mass index (BMI), weight, blood pressure, and waist circumference of 72 patients treated by LAGB procedures between September 2006 and February 2009 were measured and recorded. Pre- and postoperative 3- and 12-month C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, IgM, fibrinogen (Fbg), complement components C3 and C4, total cholesterol, triglycerides, low-density lipoprotein-C and high-density lipoprotein-C levels, and leukocyte, neutrophil, lymphocyte, and platelet counts were also measured. Results were presented as mean +/- SD. The preoperative values were compared with the 3- and 12-month values. A p value < 0.05 was considered statistically significant. RESULTS: BMI, weight, blood pressure, and waist circumference measurements were reduced at 3 and 12 months postoperatively compared with preoperative values (p < 0.05). Among the inflammatory mediators, IgG, IgM, and Fbg were reduced to near-normal values, beginning in the early postoperative period (p < 0.05). There was no significant reduction parallel to weight loss with respect to CRP, C3, C4, and IgA values at 3 months postoperatively (p > 0.05). However, the 12-month values of these parameters were significantly reduced (p < 0.05). CONCLUSIONS: Morbid obesity leads to significant changes in the levels of inflammation mediators. While there is a significant reduction in some of these mediators accompanying slight weight loss in the early period following an LAGB procedure, significant changes occur in other mediators in the late period when there is a larger amount of weight loss.

Occult intrabiliary rupture of hydatid cysts in the liver.

The aim of this study was to investigate the effects of various surgical modalities directed at the cavity of hydatid cysts in patients with occult intrabiliary rupture. In this respect, 324 patients with hydatid cyst of the liver operated on during 1983-2003 were analyzed; among them, 39 patients with occult intrabiliary rupture were included in the study. Clinical symptomatology, physical examination, laboratory findings, results of imaging studies, the localization and size of the cyst, and operative findings were reviewed. Twelve patients had complications, and there was no mortality. The most common complication was bile fistula. The average postoperative hospital stay was 7.0 +/- 3.8 days for patients with omentoplasty and 6.0 +/- 2.5 days for those who underwent cavitary drainage. For patients who do not have bile-stained cystic fluid, the utilization of scolicidal agents is appropriate. Although the opening of the duct is sutured when it is identified, the risk of biliary fistula is not clearly correlated with this approach. In such cases, omentoplasty provides a good alternative to cavitary drainage.

Use of laparoscopic splenectomy in developing countries: analysis of cost and strategies for reducing cost.

BACKGROUND: In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. PATIENT AND METHODS: Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. RESULTS: The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US $1,055 in the LS group and $1,664 in the OS group. The overall total cost was $1,664 for the OS group and $2,064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. CONCLUSION: The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.