A 6-year experience with the Swedish adjustable gastric band Prospective long-term audit of laparoscopic gastric banding.

BACKGROUND: In morbid obesity conservative therapy often fails to reduce overweight permanently. As a consequence, several bariatric surgical procedures have been developed to achieve permanent excess weight loss. Among these, the laparoscopic restrictive procedures seem to be the least invasive. The aim of this prospective study was to assess and analyze the effects, complications, and outcomes after the implantation of the Swedish adjustable gastric band (SAGB) in long-term follow-up. METHODS: All consecutive patients with implantation of a SAGB between August 1996 and August 2002 were prospectively investigated. The placement of the SAGB was done by laparoscopy in all cases. Success was rated by the reduction of body mass index (BMI) excess weight loss (EWL), and reduction of comorbidities. "Nonresponders" to SAGB were defined as <30% EWL after a 3-year follow-up. Band-related complications were recorded and classified. Patient's outcome was assessed after 6 months and subsequently each year postoperatively. RESULTS: A total of 190 patients received a SAGB, 97% of whom could be followed up with a mean follow-up period of 39.4 months (duration of follow-up, 6-72). During follow-up, a significant reduction or improvement of BMI, EWL, and comorbidities were found. Nineteen percent of patients were identified as nonresponders. Early intraoperative and postoperative complications related to SAGB were one perforation of the gastric fundus (0.5%), one conversion (0.5%), one bleeding (0.5%), and two band infections (1.1%). The SAGB-related complications encountered during long-term follow-up were three port problems (1.6%), four band migrations (2.1%), five slipping/pouch dilatations (2.6%), and two band leakages (1.1%). All intra- and postoperative SAGB-related complications accounted for a total morbidity of 10.5%. Operative mortality was 0%. The overall reoperation rate was 8.5%. CONCLUSIONS: In long-term follow-up, SAGB is safe and effective. Our results demonstrate a significant EWL of 50% during the first 24 months. However, patient selection has to be improved to reduce the nonresponder rate. SAGB leads to a significant reduction of obesity-related comorbidities. SAGB is an attractive alternative in the surgical treatment of morbid obesity.

[Does laparoscopy influence the treatment of choledocholithiasis?]. / Beeinflusst die Laparoskopie die Behandlung der Choledocholithiasis?

Operative common bile duct exploration, performed in conjunction with cholecystectomy, used to be considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. The advent of laparoscopic cholecystectomy (LC) has affected the management of common bile duct stones. More emphasis is placed on preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) with endoscopic papillotomy (EP) either just before or soon after laparoscopic surgery. This involves the patient in an additional procedure with its associated risks. Single-stage treatment of biliary lithiasis, i.e. LC and laparoscopic common bile duct exploration (LCDE) appears preferable to two-stage treatment, especially when the ampulla of Vater can be preserved. 550 consecutive patients with LC are reviewed. IVC with tomography was performed in 341 of these patients without complications and with a sensitivity of 75% and a specificity of 99%. The procedure failed in 5.6% due to poor quality imaging, and was contraindicated in 21 patients. With increasing laparoscopic experience, intraoperative cholangiography (IOC) was adopted and has been used routinely since November 1992. IOC was successful in 204 of 209 attempts (97.6%) with a sensitivity of 95% and a specificity of 100%. The mean operation time for IOC was 10 minutes. Unsuspected bile duct stones were found in 6% of instances. IOC demonstrated one choledochotomy (0.18% of all LC), thus preventing transsection of the duct. 47 patients (8.5%) had common duct stones. 29 (62%) were treated by ERC and EP, while 18 (38%) underwent LCDE. Successful clearance was achieved endoscopically in 94% and laparoscopically in 82% of the attempts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopic intestinal surgery]. / Laparoskopische Darmchirurgie.

The objective of the present study was to demonstrate the feasibility of laparoscopic bowel surgery. From June 1990 to September 1993 14 small bowel and 15 colon operations were performed laparoscopically in the surgical department of Aarberg Hospital. The results have been analyzed retrospectively. The indication for all small bowel operations was intestinal obstruction. Adhesiolysis, hernia repair and resections were performed either by laparoscopy or by laparoscopically assisted surgery. There were no complications. Laparoscopy therefore has proven to be a good method for treating intestinal obstruction of various origin. 11 colon resections were performed without anastomotic leakage. There were two conversions to laparotomy. Three complications occurred but resolved spontaneously. Two patients died from causes unrelated to the laparoscopic procedure. Our results demonstrate that laparoscopic resections of the colon are feasible. Further evaluation is needed to assess their clinical value.

[Disease course in 20 patients with an early diagnosis of phenylketonuria and hyperphenylalaninemia]. / Verlauf bei 20 Patienten mit frühentdeckter Phenylketonurie und Hyperphenylalaninämie.

Twenty patients with PKU or hyperphenylalaninemia at ages 0.1 to 15.6 years (median age 6.2 years) were studied prospectively. In all children the condition had been diagnosed when they were neonates on the basis of an abnormal Guthrie test. To maintain plasma phenylalanine levels between 0.2-0.5 mM, dietary restriction of phenylalanine to 20-80 mg/kg daily (median 40 mg/kg) was necessary in 14 children. In children above 8 years, however, these plasma levels were frequently exceeded. In 6 children plasma phenylalanine levels were higher than normal diet. Height, weight and head circumference were within normal range in all patients at all ages. Determinations of DQ/IQ were done at 2, 4, 6 and 8 years of age and revealed values between 90-120 with a median of 102 in the 14 patients who were tested. Only 1 patient had IQ levels between 75-85 and attended special school. Nine other patients were in grade school performing averagely or above. This study confirms that early treatment and long-term follow-up of patients with PKU yield good results. Unsolved problems include duration of dietary treatment and the management of pregnancy in women with PKU.