Dietetic-led management of patients undergoing laparoscopic gastric banding: early results.

BACKGROUND: Optimal results of bariatric surgery are achieved when it is performed within a multidisciplinary team. Within this team, the dietician plays a key role before and after surgery in patient education and behaviour change. With long-term follow-up, the number of patients per surgeon increases exponentially. This study evaluated the outcomes of a dietician-only led management program for patients who underwent laparoscopic gastric banding in our unit. METHODS: Between April 2003 and November 2007, 1,335 patients underwent laparoscopic gastric banding in two hospitals by the same surgical team. Weight loss outcomes were compared for patients in a dietician-led management program against a surgeon/nurse specialist follow-up program with more frequent patient visits. For the dietician-led group, a standard protocol of six postoperative visits and two to three fluoroscopic adjustments was developed from referral until 2 years after surgery. RESULTS: There were 316 patients followed up in a dietician-led program. They were compared with the remaining patients who were followed up in a surgeon/ nurse specialist led program. The mean preoperative weight and body mass index (BMI) for the dietetic-led subset was significantly higher (weight: 147.4 +/- 30.2; BMI: 52.8 +/- 8.9) compared with the remaining group (weight: 113.8 +/- 18.7; BMI: 41.6 +/- 5.2; p < 0.001: Mann-Whitney test). Percent BMI loss was initially lower in the dietician-led group, but this difference disappeared at the end of 24 months (p = 0.056). CONCLUSIONS: A patient management program led by specialist dieticians is an effective way to manage large numbers of patients after laparoscopic gastric banding while maintaining comparable weight loss to surgeon/nurse-led series.

Age > or =50 does not influence outcome in laparoscopic gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding is an accepted treatment for obesity. Age greater than 50 carries a theoretically increased risk from weight loss surgery and perhaps less clinical benefit in the long term. We compare results of gastric banding at age 50 and above with age below 50 in our unit. METHODS: Between April 2003 and November 2007, 1,335 patients, mean weight 121.7 kg (range 73-268 kg), mean body mass index (BMI) 44.1 kg/m(2) (range 35-99), underwent gastric banding. Three hundred and twenty four patients had age > or =50. Band adjustments were usually carried out using fluoroscopy. RESULTS: There was no statistically significant difference in the preoperative weights and BMIs for the two patient groups (age < 50: weight 120.7 +/- 24.9, BMI 43.6 +/- 7.3 kg/m(2); age > or = 50: weight 118 +/- 23.7 kg, BMI 43.8 +/- 7 kg/m(2)). Similarly, there was no statistically significant difference with regards to excess percent BMI loss in the two groups over 36 months (age < 50 = 49 +/- 27.9; age > or = 50 = 47.3 +/- 35.1). There was no difference in the incidence of complications with patient age. CONCLUSION: These results demonstrate that, at age > or =50, this procedure is successful in producing weight loss and, at the same time, has a complication rate comparable to younger patients.

Metabolic outcomes of obese diabetic patients following laparoscopic adjustable gastric banding.

INTRODUCTION: Obesity is an independent risk factor in the development of diabetes. Weight loss surgery is the most effective treatment of morbid obesity. This study examines the effect of gastric banding on metabolic profile in diabetics. METHODS: Between April 2003 and November 2007, 1,335 patients underwent laparoscopic adjustable gastric banding. Metabolic profile was examined on a subset of 254 patients. Of these, 122 were diabetic. Data collection included body mass index, weight, blood pressure, HbA1c, fasting glucose, total serum cholesterol, triglyceride, and medications taken for blood pressure and diabetes both preoperatively and 1 year postoperatively. RESULTS: Comorbid conditions in the diabetic patients included hypercholesterolemia (49.3%), hypertriglyceridemia (53.8%) and hypertension (92%). In 1 year, mean BMI reduced from 52.9 kg/m(2) to 41.5 kg/m(2). Of the patients, 93.1% experienced an improvement in fasting glucose levels and 75.4% patients an improvement in HbA1c levels at the end of 1 year. All patients experienced a decrease in insulin requirements, and 36.6% were able to totally discontinue using it. Of the patients, 100% showed improvement in their triglyceride level, and 90.9% showed improvement in their total cholesterol level. The mean arterial pressure improved in 87.5% of the patients. CONCLUSION: The metabolic syndrome associated with morbid obesity is difficult to adequately control with medication. Laparoscopic gastric banding can be considered a potentially curative treatment option in the management of this syndrome.

The "Birmingham stitch"--avoiding slippage in laparoscopic gastric banding.

BACKGROUND: Slippage rates of 1.4-24 % are frequently quoted after adjustable gastric banding. This complication can be extremely serious and has contributed to many units offering more invasive interventions in the surgical management of morbid obesity. We present results of the first 1,140 Laparoscopic Bands performed in our unit. METHODS: Between April 2003 and June 2007, 1140 consecutive patients, mean weight 121.5 kg (range 73-268 kg), mean body mass index (BMI) 44.3 kg/m(2) (range 35-88) underwent laparoscopic adjustable gastric banding (LAGB). An identical surgical technique of one gastropexy suture in addition to the two routine gastro-gastro tunnel sutures was used in all cases. Fluoroscopy-guided adjustments were performed at 3 and 6 months and fluoroscopic evaluations were performed later if clinically indicated. RESULTS: There was no mortality and only one major septic complication of gastric perforation 1 week postoperatively which was managed conservatively. The mean stay was 1.02 days (range 0-30 days). Excess percent BMI loss in these patients at 3, 6, 12, 18, 24, 30, and 36 months were 25.4%, 34.7%, 38.3%, 41.1%, 43.7%, 44.4%, and 58.9%, respectively. Slippage with urgent readmission occurred in one patient (0.08%) at 5 months. Two partial slippages were noticed at 12 and 18 months, respectively. One patient had the band removed and the other was treated by band deflation and repositioning 6 months later. CONCLUSION: These results demonstrate that in our unit, laparoscopic gastric band insertion is successful in producing weight loss and at the same time has a very low slippage and pouch dilatation rate. This difference is most probably secondary to operative technique.