Does laparoscopic gastric banding create hiatal hernias?

Azagury, Dan E.; Varban, Oliver A.; Tavakkolizadeh, Ali; Robinson, Malcolm K.; Vernon, Ashley H.; Lautz, David B.

doi:10.1016/j.soard.2011.07.015

Cited by 20 publications

(3 citation statements)

References 20 publications

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“…This is the reason why we abandoned the adjustable band procedure in 2004 in our department. Conversely, the bypass procedure is indeed fully reversible [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)

Vilallonga

Himpens

Vrande³

2016

Obes Facts

103

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Background: Few data are available about obesity surgery in adolescent patients. Objective: To assess long-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients <18 years. Setting: University Hospital, Europe. Methods: A retrospective study of prospectively collected data of patients <18 years (childhood group; ChG) (n = 28) treated by LRYGB of which 19 were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). This group of patients was matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period. The extensive survey included a telephonic questionnaire. Results: 19 (12 females) of the 28 patients (67.9%) were available for follow-up. Preoperatively, 3 had type 2 diabetes mellitus (T2DM), 1 arterial hypertension, 5 dyslipidemia and 1 sleep apnea. In the ChG, average BMI after 7 years dropped from 38.9 kg/m² preoperatively to 27.5 kg/m². In the AdG, average BMI decreased from 39.4 to 27.1 kg/m² in the same time period (nonsignificant between groups). One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions). All patients resolved their initial comorbidities. Two of 12 female patients in the ChG became pregnant 6 and 8 years after surgery, respectively, despite seemingly adequate oral contraception. Compliance with postoperative guidelines was good in 16/19 patients in ChG and in 14/18 patients in the AdG. Overall degree of satisfaction was high: 8.2/10 (SD 1.2, range 6-10) in the ChG and 8.9/10 (SD 1.7, range 5-10) in the AdG. Conclusion: LRYGB seems to be safe, provide good weight loss, and cure comorbidities in an adolescent population. Satisfaction degree is high. Inadvertent pregnancy despite conventional contraception is a possible issue.

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“…This is the reason why we abandoned the adjustable band procedure in 2004 in our department. Conversely, the bypass procedure is indeed fully reversible [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)

Vilallonga

Himpens

Vrande³

2016

Obes Facts

103

View full text Add to dashboard Cite

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“…That being said, it is not without its complications, and a growing body of evidence is demonstrating that AGB is related to complications, such as HH development, which is a complication that is typically associated with other bariatric procedures. The mechanisms behind LAGB complications, such as HH, are still being investigated [ 11 ]. Several studies have proposed reasons behind the development of HH after gastric banding.…”

Section: Reviewmentioning

confidence: 99%

“…Gulkarov et al proposed that crural defects at the esophageal hiatus could allow for the periodic displacement of the gastroesophageal junction up into the thorax [ 9 ]. Azagury et al proposed that complications such as concentric pouch dilation, esophageal dilation, and HH are likely to have the same etiology and classified them together as “backpressure syndrome”; depending on the weakest link, the pressure will induce concentric pouch dilation, esophageal dilation, or a combination of three [ 11 ]. The presence of a new HH after LAGB and the role of LAGB in potentially creating hiatal hernias has not been thoroughly assessed in the literature; however, Azagury et al identified 12 patients out of 695 who needed to undergo reoperation for HH, and who had no evidence of hiatal hernia radiographically or by visualization during the primary operation [ 11 ].…”

Section: Reviewmentioning

confidence: 99%

Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis

Majdoubeh¹,

Hassan²,

Alhalawa³

et al. 2022

Cureus

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Worsening hiatus hernia (HH) symptoms have been well recognized as a complication of gastric banding, however, it has not yet been explored whether gastric banding plays a role in the development of HH de novo in patients undergoing gastric banding. From the 696 studies identified, five studies met the eligibility criteria and were included. Data was extracted from PubMed, Embase, Medline, HMIC, and Web of Science databases. The pooled complication rate was evaluated along with 95% confidence intervals (95% CIs). The meta-analysis was performed using the Cochrane RevMan tool (Cochrane, London, UK). Heterogeneity was tested using the I 2 index for each outcome. All the included studies assessed HH incidence among followedup patients who needed a re-operation for upper gastrointestinal symptoms. Between-study variability was high (I 2 = 94%, Chi 2 = 68.92, df = 4, < 0.00001, Tau2=1.91). Complication rate ranged between 0.24% to 5.55%; pooled complication rate was 2.17% CI 95% (0.90 -3.44%) P = 0.0008. The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least. Further research is needed to underpin the mechanism and confirm causation. However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.

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Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass

Gautier

2014

JAMA Surg

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laparoscopic adjustable gastric banding (LAGB) at 3 years had only a median of 15.9% of baseline weight loss compared with 31.5% for Roux-en-Y gastric bypass (RYGB). Also, there were 77 subsequent procedures following 610 LAGBs during 3 years vs 4 subsequent procedures in more than 1691 RYGBs. Hence, conversion of adjustable gastric banding to another intervention (sleeve gastrectomy, gastric bypass, or duodenal switch) is on the rise. In this issue of JAMA Surgery, Thereaux et al 2 have retrospectively reviewed their prospective database of a singleuniversity surgical center and compared primary gastric bypass with revision gastric bypass, mainly bands revised to gastric bypass. However, the authors looked only at 30-day outcomes because one would be interested in weight loss differences over time, marginal ulcer incidence, gastric pouch enlargement, and gastroesophageal reflux disease, with or without hiatal hernias and esophagitis. In 831 patients who had primary gastric bypass and in 177 patients who had conversion of gastric banding to gastric bypass, the 30-day major outcome rates were similar (7.8% and 8.5%, respectively).Their article diverges from previous Longitudinal Assessment of Bariatric Surgery data in which revision surgery was associated with more severe complications. 3 In that study, compared with those undergoing revision surgery, primary surgery patients with obesity were younger and more likely to be male, weigh more, and have more comorbidity. This was not the case in the 2013 series, in which conversion from LAGB to RYGB was associated with a higher percentage of female patients and with fewer comorbidities. 1 Therefore, one can conclude that the groups were not comparable and were highly selected before surgery. In the earlier study, 3 operative time for revision procedures was longer and associated with greater blood loss, and adverse outcomes were more frequent after revision surgery (15.1% vs 5.3%, P < .001).There is not always an easy reversal or removal of an adjustable gastric band. The foreign body is known to have caused severe capsular reactions, taking the left lobe of the liver, diaphragm, gastric remnant, superior pole of the spleen, and pan- creas posteriorly. Hence, this dissection time is added to the procedure, and longer operating time in bariatric surgery under a pneumoperitoneum of 15 mm Hg increases the likelihood of complications, such as thromboembolism, and gastric pouch construction may not be optimal. Thereaux et al 2 havenot provided the number of stapling events required to fashion their pouch; a safe margin from the band would be necessary to create a healthier and well-vascularized anastomosis. The leftover capsule remodels to become thinner over time, and the gastric pouch is likely to expand to an unusual size, causing a higher risk for marginal ulceration. A larger pouch is also likely to increase the frequency of weight regain later (beyond 3 years), and a few patients may need a second revision. In that sense, a 2-stage approach may be more desirable. Att...

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Does laparoscopic gastric banding create hiatal hernias?

Cited by 20 publications

References 20 publications

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)

Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis

Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass

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