A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways

O'Brien, Paul Edmond; Dixon, John; Laurie, Cheryl; Anderson, M. Robin

doi:10.1381/0960892054222858

Cited by 213 publications

(107 citation statements)

References 11 publications

Supporting

Mentioning

103

Contrasting

Order By: Relevance

“…O'Brien et al [5] reported, in a prospective randomized study of 202 patients followed for 24 months, that the pars flaccida pathway makes a significant difference in gastric prolapse reduction. Similar improvement in SF36 scores for quality of life and weight loss were also recorded.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients

Lorenzo¹,

Furbetta²,

Favretti³

et al. 2010

Surg Endosc

View full text Add to dashboard Cite

Aim Retrospective multicenter analysis of the results of two different approaches for band positioning: perigastric and pars flaccida. Methods Data were collected from the database of the Italian Group for LapBand Ò (GILB). Patients operated from January 2001 to December 2004 were selected according to criteria of case-control studies to compare two different band positioning techniques: perigastric (PG group) and pars flaccida (PF group). Demographics, laparotomic conversion, postoperative complications, and weight loss parameters were considered. Data are expressed as mean ± standard deviation. Results 2,549 patients underwent the LapBand System Ò procedure [age: 40 ± 11.7 years; sex: 2,130 female, 419 male; body mass index (BMI): 46.4 ± 6.9 kg/m 2 ; excess weight (EW): 60.1 ± 23.6 kg; %EW: 90.1 ± 32.4]. During this period 1,343/2,549 (52.7%) were operated via the pars flaccida (PF group) and 1,206/2,549 (47.3%) via the perigastric approach (PG group). Demographics for both groups were similar. Thirty-day mortality was absent in both groups. Operative time was significantly longer in the PG group (80 ± 20 min versus 60 ± 40 min; p \ 0.05). Hospital stay was similar in the two groups (2 ± 2 days). Laparotomic conversion was significantly higher in the PG group (6 versus 2 patients; p \ 0.001). Overall postoperative complication rate was 172/2,549 (6.7%) and was linked to gastric pouch dilation/slippage (67/172), intragastric migration/erosion (17/172), and tube/port failure (88/172). Gastric pouch dilation and intragastric migration were significantly more frequent in the PG group: 47 versus 20 (p \ 0.001) and 12 versus 5 (p \ 0.001), respectively. Patients eligible for minimum 3-year follow-up were 1,118/1,206 (PG group) and 1,079/1,343 (PF group). Mean BMI was 33.8 ± 12.1 kg/m 2 (PG group) and 32.4 ± 11.7 kg/m 2 (PF group) (p = ns), and mean percentage excess weight loss (%EWL) was 47.2 ± 25.4 and 48.9 ± 13.2 in PG and PF groups, respectively (p = ns). Conclusions Significant improvement in LapBand System Ò results with regard to laparotomic conversion and postoperative complication rate, with similar weight loss results, was observed in the pars flaccida group.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients

Lorenzo¹,

Furbetta²,

Favretti³

et al. 2010

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…This variability is unlikely related to different gastric banding devices or techniques, as previous trials have demonstrated. 28,29 Our data not only demonstrate marginal absolute weight loss with LAGB, but also superior comparative weight loss with LSG and RYGB, and greater reduction in obesity-related comorbidities with RYGB. Accordingly, in a shared decision-making model, our study will inform patients and referring physicians of the relative lack of effectiveness of the band for weight loss and comorbidity resolution.…”

Section: Comparisonmentioning

confidence: 63%

Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

Gill

Majumdar

Rueda-Clausen

et al. 2016

cjs

View full text Add to dashboard Cite

Background: Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program. Methods:We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data. Results:We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (-13.0 ± 6.6) than both the LSG (-7.6 ± 5.7) and the LAGB (-2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%. Conclusion:In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe.Contexte : Au Canada, la chirurgie bariatrique est effectuée principalement dans des cliniques spécialisées financées par le secteur public. Des études ont démontré que les interventions de cette nature sont supérieures à la prise en charge médicale intensive pour la perte de poids et la réduction des affections comorbides liées à l'obésité. L'objectif de notre étude était de comparer l'efficacité et l'innocuité de la dérivation gastrique Roux-en-Y par laparoscopie (DGRY), de la gastrectomie longitudinale (GL) et de la gastroplastie par anneau gastrique modulable (GAGM) dans le cadre d'un programme de traitement bariatrique basé sur la population financé par les deniers publics.Méthodes : Nous avons suivi pendant 2 ans des patients ayant subi une chirurgie bariatrique. Le résultat primaire à l'étude était la variation pondérale (en kilogrammes). Nous avons analysé la variation intergroupe au moyen d'une régression multivariable et utilisé la méthode d'imputation des données manquantes par report de la dernière observation.Résultats : Nous avons retenu 150 patients consécutifs (51 DGRY; 51 GL; 48 GAGM). Au début de l'étude, l'âge moyen était de 43,5 ± 9,5 ans, 87,3 % des patients étaient des femmes, et leur indice de masse corporelle (IMC) avant l'opération était de 46,2 ± 7,4. Après 2 ans, la perte de p...

show abstract

“…There are two known techniques for dissection before LAGB placement: (1) The traditional perigastric pathway that requires dissection between the lesser curvature of stomach and lesser omentum, across the apex of the lesser sac, to the angle of His; and (2) the more recent technique of using the Pars flaccida pathway, in which dissection is made from the base of the right crus, along the left crus to the angle of His. O'Brien et al 12 found that the using the Pars flaccida pathway is as effective as using the perigastric pathway in generating substantial weight loss, improved health, and improved quality of life, and it is significantly less likely to be associated with prolapse (slippage). Although the presented data suggest as a general recommendation that surgeons should prefer the Pars flaccida approach, Di Lorenzo et al 13 suggested that the perigastric technique must be considered because in expert hands, it has good results as well, with a low complication rate.…”

Section: Discussionmentioning

confidence: 99%

Acute Presentation of Laparoscopic Gastric Band Erosion

Bawahab

2015

CRSLS

View full text Add to dashboard Cite

Laparoscopic adjustable gastric band (LAGB) is a well-established bariatric surgical procedure. LAGB surgery is associated long term with a significant chance for reoperation within 10 years of band placement; 2 causes of reoperation are band migration and erosion. LAGB migration is a common late complication of gastric band, with a reported incidence of as much as 11%. Herein we present a patient with LAGB erosion presenting as small bowel obstruction. In our patient, the LAGB had completely eroded into the stomach and migrated through the pylorus to the upper jejunum, resulting in a small bowel obstruction. We describe our laparoscopic approach and management of this complication, which requires a high index of suspicion.

show abstract

A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways

Abstract: The PF pathway is as effective as the PG pathway in generating substantial weight loss, improved health and improved quality of life and is significantly less likely to be associated with prolapse (slippage). It is recommended as the primary dissection pathway.

Cited by 213 publications

References 11 publications

Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients

Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients

Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

Acute Presentation of Laparoscopic Gastric Band Erosion

Contact Info

Product

Resources

About