Do Male Patients Benefit from Laparoscopic Adjustable Gastric Banding More than Female Patients? A Retrospective Cohort Study.

BACKGROUND: Clinical trials in the field of bariatrics, and specifically laparoscopic adjustable gastric banding (LAGB), have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results, and specifically quality of life (QOL) parameters, have not been addressed sufficiently. The aim of our study was to examine the long-term gender association with outcome of LAGB including the impact on QOL. METHODS: A retrospective cohort study of patients who underwent LAGB between 2006 and 2014 by a single surgeon was conducted. Data were collected from the hospital registry and a telephone interview that included a standardized questionnaire. Outcomes including BMI reduction, evolution of comorbidities, complications, reoperations, and QOL were compared according to the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS: Included were 114 males and 127 females, with a mean age of 38.2 years at surgery, and an average post-surgery follow-up of 6.5 years. Similar BMI reduction (p = 0.68) and perioperative complication rates (p = 0.99) were observed. Males had a greater improvement in comorbidities (p < 0.001), less band slippage (p = 0.006), underwent fewer reoperations (p = 0.02), and reported higher QOL scores (p = 0.02) than females. The total BAROS score was significantly higher for males than females (p < 0.001). CONCLUSIONS: LAGB surgery results in better outcomes for male than female patients as measured by the BAROS, despite a similar BMI reduction. Gender-specific outcomes should be taken into consideration in optimizing patient selection and preoperative patient counseling.

Body contouring surgery decreases long-term weight regain following laparoscopic adjustable gastric banding: A matched retrospective cohort study.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) surgery is the safest yet least effective method for massive weight loss. Thirty to 50 percent of patients undergoing LAGB will regain part of their lost weight. OBJECTIVE: To evaluate the effect of body contouring plastic surgery (BCPS) following LAGB on long-term body mass index (BMI) control. SETTING: Department of Surgery A, Soroka University Medical Center, Beer-Sheva, Israel. METHODS: A retrospective cohort study of patients aged 18-50 years, who underwent LAGB surgery between 1997 and 2007, was performed. Out of 2405 patients undergoing LAGB during those years, 861 were excluded and 1544 were recruited by phone. The final group included 72 patients matched for age and gender. Long-term weight regain was evaluated and compared between a group of patients who underwent subsequent body contouring plastic surgery (LBCPS) and a group of LAGB only (LAGBO). Groups were matched for age, gender, and pre-operative body mass index (BMI). RESULTS: LBCPS (n = 18) had lower endpoint BMI and BMI regain percentage compared with LAGBO (n = 54) (24.64 ± 3.76 vs. 31.0 ± 7.2 kg/m2, p < 0.001; 13 ± 14% vs. 34± 31%. p < 0.001, respectively). BCPS had an independent strong protective effect for endpoint BMI regain over 25% and BMI ≥30 kg/m2 (HR = 0.19, p = 0.025; HR = 0.13, p = 0.046, respectively). CONCLUSION: When compared with patients who did not undergo BCPS following LAGB, patients who underwent BCPS following LAGB had improved long-term BMI control.

[Gastric banding for extensive treatment of morbid obesity].

BACKGROUND: Morbid obesity results in multiple comorbidities and an increased rate of mortality. Laparoscopic adjustable gastric banding (LAGB)--a restrictive operation, has been found to be a safe, effective and durable tool in the management of morbid obesity. OBJECTIVE: Through clinical observation, the authors evaluate whether the effect of LAGB on the adjustment of the patients to the new mode of food intake and their change in lifestyle while losing weight, is restrictive or beyond. METHOD: During the last decade, 5000 patients underwent LAGB and were followed up in our outpatient clinic by a single team. Careful observations and interviews contributed to our expending database. RESULTS: The data we collected during their visit is presented as a four phase eating habits model which describes the changes in quality and manner of life while reducing weight. CONCLUSIONS: The mechanism of LAGB for losing weight is beyond the restrictive effect of the band.

Technical tips for laparoscopic gastric banding: 6 years' experience in 2800 procedures by a single surgical team.

OBJECTIVE: We present a modified method for laparoscopic gastric banding (LGB) based on the extensive personal experience of a single team, and propose a list of comprehensive technical tips that should shorten the operation time, reduce the hospital stay, and minimize the complication rate. BACKGROUND: Gastric banding is probably the most commonly performed bariatric procedure in Europe and Australia, as well as in Israel. Because of its minimal invasiveness, efficacy, safety, reversibility, and adjustability, it is considered a breakthrough in bariatric surgery. METHODS: From December 1997 to December 2003, 2800 morbidly obese patients underwent LGB performed by a single team. All patients strictly met the criteria for surgery as defined by the National Institutes of Health (NIH). We excluded patients with psychiatric disorders, profound incompliance, mental retardation, and portal hypertension. Our modified technique focused especially on positioning of the port sites, retro-gastric transit of the band, band fastening, and placement of the injecting port (IP). RESULTS: The mean overall operative time was 32 minutes. The mean hospital stay was 23 hours. Follow-up took place between 24 to 96 months, and mean body mass index (BMI) postsurgery was 29 +/- 3.2. The overall morbidity rate was 10%. Gastric perforation occurred in 5 patients. No operative or immediate postoperative deaths occurred. One patient died 8 days postoperatively due to massive pulmonary embolism. CONCLUSION: Our satisfactory results were achieved by employing the proposed technical tips and adapting "do and don't" rules. We believe that the following compelling data will contribute to the increasing use of LGB worldwide.

The experience with a modified technique for laparoscopic ventral hernia repair.

In this article, we describe a modified technique for laparoscopic ventral hernia repair that is easy to perform and teach. The three-keyhole process comprises two major steps: laparoscopic appreciation of the outlet dimension of the hernia and pin-tucking an appropriately sized polytetrafluoroethylene patch after the smooth face has been oriented toward the viscera. We report our experience of 231 patients who underwent the procedure electively between January 1997 and December 2001 with satisfactory results. We suggest that this method be used for all hernia defect-sized elective incisional hernias.