Esophageal dysmotility disorders after laparoscopic gastric banding--an underestimated complication.

OBJECTIVE: To evaluate the effects of laparoscopic adjustable gastric banding (LAGB) on esophageal dysfunction over the long term in a prospective study, based on a 12-year experience. BACKGROUND: Esophageal motility disorders and dilatation after LAGB have been reported. However, only a few studies present long-term follow-up data. METHODS: Between June 1998 and June 2009, all patients with implantation of a LAGB were enrolled in a prospective clinical trial including a yearly barium swallow. Esophageal motility disorders were recorded and classified over the period. An esophageal diameter of 35 mm or greater was considered dilated. RESULTS: Laparoscopic adjustable gastric banding was performed in 167 patients (120 females and 47 males) with a mean age of 40.1±5.2 years. Overall patient follow-up was 94%. Esophageal dysmotility disorders were found in 108 patients (68.8% of patients followed). Esophageal dilatation occurred in 40 patients (25.5%)with a mean esophageal diameter of 47.3±6.9 mm(35.0­94.6) after a follow-up of 73.8 ± 6.8 months (36­120) compared with 26.2± 2.8 mm (18.3­34.2) in patients without dilatation (diameter of <35 mm)(P < 0.01). Thirty-four patients suffered from stage III dilatation (band deflation necessary) and 6 from stage IV (major achalasia-like dilatation, band removal mandatory). In 29 patients, upper endoscopy was carried out because of heartburn/dysphagia. In 18 patients, the endoscopy was normal; 9 patients suffered from gastroesophageal reflux disease, 1 from a stenosis, and 1 from a hiatus hernia. CONCLUSIONS: This study demonstrates that esophageal motility disorders after LAGB are frequent, poorly appreciated complications. Despite adequate excess weight loss, LAGB should probably not be considered the procedure of first choice and should be performed only in selected cases until reliable criteria for patients with a low risk for the procedure's long-term complications are developed.

Graft survival and complications after laparoscopic gastric banding for morbid obesity--lessons learned from a 12-year experience.

Laparoscopic adjustable gastric banding (LAGB) has been considered by many as the treatment of choice for morbid obesity because of its simplicity and encouraging early results. The aim of this prospective study was to critically assess the effects, complications, and outcome after LAGB in the long-term, based on a 12-year experience. Between June 1998 and June 2009, all patients with implantation of a LAGB have been enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications, re-operation rate, and graft survival. LAGB was performed in 167 patients (120 female, 47 male) with a mean age of 40.1 +/- 5.2 years. Operative mortality was 0%, overall 1.2% (not band-related). Overall patient follow-up was 94.0%. Mean excess weight loss (EWL) after 1, 2, 5, 8, and 10 years was 31.1 +/- 7.5% (p < 0.005), 44.2 +/- 6.5% (p < 0.001), 50.3 +/- 6.9% (p < 0.001), 51.7 +/- 6.3% (p < 0.001), and 48.8 +/- 6.0% (p < 0.001), respectively. The non-responder rate (EWL < 30%) after 2, 5, 8, and 10 years was 24.5%, 18.3%, 12.5%, and 16.6%, respectively. The early complication rate (<30 days) was 7.8% (13/167), with 10 minor and three major complications. Late complications (>30 days) occurred in 40.1% (67/167), of whom seven were minor and 60 were major complications (three band infections, two band migrations, 11 band leakages, two slippings/pouch dilatations, two band intolerances, and 40 esophageal dilatations). The overall re-operation rate was 20.4% (34/167). The graft survival of the implanted band after 2, 5, 8, 10, and 12 years was 98.8%, 94.0%, 86.8%, 85.0%, and 85.0%, respectively. The failure rate of the procedure after 2, 5, 8, and 10 years was 25.7%, 24.3%, 25.7%, and 31.6%, respectively. In the present long-term high-participation follow-up study, LAGB is a safe and effective surgical treatment for morbid obesity. However, the high complication, re-operation, and long-term failure rates lead to the conclusion that LAGB should be performed in selected cases only, until reliable criteria for patients at low risk for long-term complications are developed.

Outcome and complications after laparoscopic Swedish adjustable gastric banding: 5-year results of a prospective clinical trial.

BACKGROUND: Bariatric surgery is currently the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and decreasing weight-related co-morbidities. A study was conducted to assess the effects, complications and outcome after laparoscopic Swedish adjustable gastric banding (SAGB) to 5 years. METHODS: Between June 1998 and December 2005, all patients with implantation of a SAGB were enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications and re-operation rate. RESULTS: SAGB was performed in 128 patients (87 female, 41 male). Mean age was 40.2 +/- 5.3 years, with mean preoperative BMI 44.5 +/- 3.9 kg/m2. Overall mortality was 0%. Patient follow-up was 94.5%. BMI after 1, 2 and 5 years was 35.7 +/- 3.7 kg/m2 (P < 0.005), 33.7 +/- 3.8 kg/m2 (P < 0.001) and 31.8 +/- 3.8 kg/m2 (P < 0.001), respectively. Mean EWL after 1, 2 and 5 years was 33.3 +/- 6.8% (P < 0.005), 45.5 +/- 6.4% (P < 0.001) and 57.4 +/- 6.5% (P < 0.001), respectively. The nonresponder rate (EWL < 30%) after 2 and 5 years was 17.0% and 6.8%, respectively. The early complication rate (< 30 d) was 6.25% (8/128), with 5 minor and 3 major complications. Late complications (> 30 d) occurred in 10.9% (14/128), of whom 2 were minor and 12 were major complications. The overall re-operation rate was 11.7% (15/128). CONCLUSIONS: At 5-year follow-up, laparoscopic SAGB is a safe and effective surgical treatment for morbid obesity. Our results appear to confirm that SAGB is a safer surgical treatment regarding rate and severity of complications compared with gastric bypass and malabsorptive procedures.