Effects of Gastric Band Adjustments on Intraluminal Pressure

Burton, Paul R.; Brown, Wendy A.; Laurie, Cheryl; Richards, Melissa N.; Hebbard, Geoffrey; O'Brien, Paul Edmond

doi:10.1007/s11695-009-9950-3

Cited by 32 publications

(23 citation statements)

References 10 publications

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“…This is based on successful patients consistently demonstrating an intraluminal pressure in the range of 25-30 mm Hg at the level of the LAGB. 7,19 This is despite variation in the device and the volume of saline within the LAGB, suggesting that the intraluminal pressure is important in mediating successful weight loss.…”

Section: Intraluminal Pressure Effectsmentioning

confidence: 99%

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The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9±19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5±2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.

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Section: Intraluminal Pressure Effectsmentioning

confidence: 99%

“…19 Subsequent addition of more saline resulted in a rapid, linear increase in intraluminal pressure. Although the threshold volume varied substantially between patients and type of gastric band, the rate of increase after this threshold had been achieved was similar between patients.…”

Section: Intraluminal Pressure Effectsmentioning

confidence: 99%

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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“…These fi ndings suggest that the higher intraluminal pressure in the gastric fundus generated as a result of placement of the band itself, and further amplifi ed by food intake, may trigger a cascade of signalling in the vagus-brainstem-hypothalamic axis resulting in decreased caloric intake and weight loss. The optimal pressure of 25-30 mmHg within the banding system is achieved through insertion of different amounts of fl uid between patients, with exponential increase in pressure when too much fl uid is inserted [ 41 ]. It is therefore crucial that adjustments are carefully made if the unwanted complication of mechanical restriction and vomiting are to be avoided.…”

Section: Neural Signalling After Bariatric Surgerymentioning

confidence: 99%

Mechanisms of Bariatric Surgery

Miras

Roux

2014

Treatment of the Obese Patient

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“…High-resolution manometry has clarified some of the effects of the LAGB on esophageal motility [6,8]. Normal contractility, with an attenuated lower esophageal sphincter that relaxes appropriately, is observed in successful patients [6].…”

Section: Introductionmentioning

confidence: 99%

Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment

et al. 2009

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The LECS is a valuable measure of esophageal function in LAGB patients and complements conventional manometric criteria. Symptomatic patients have less normal swallows; however, these also frequently demonstrate a deficient LECS. Further information can be elucidated by performing swallows at differing LAGB volumes. High-resolution manometry, using these adapted criteria, is now a useful in the investigation in symptomatic LAGB patients.

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Effects of Gastric Band Adjustments on Intraluminal Pressure

Cited by 32 publications

References 10 publications

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Mechanisms of Bariatric Surgery

Criteria for Assessing Esophageal Motility in Laparoscopic Adjustable Gastric Band Patients: The Importance of the Lower Esophageal Contractile Segment

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