Outcomes, Satiety, and Adverse Upper Gastrointestinal Symptoms Following Laparoscopic Adjustable Gastric Banding

Burton, Paul R.; Brown, Wendy A.; Laurie, Cheryl; Lee, M.; Korin, Anna; Anderson, M. Robin; Hebbard, Geoff; O'Brien, Paul Edmond

doi:10.1007/s11695-010-0073-7

Cited by 36 publications

(30 citation statements)

References 18 publications

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“…The introduction of more modern bands adapted to the laparoscopic approach and the implementation of a more prudent strategy for postoperative band adjustments, might have permitted a reduction in vomiting frequency after surgery. However, in a recent cross-sectional analysis of 323 patients treated with LAGB from 2003 to 2007, Burton et al [24] reported 9% of patients with daily food regurgitation and an additional 23% of patients having regurgitation more frequently than once per week. The inability to consume a range of foods because of the regurgitation was cited in their study as the most troublesome symptom or problem after surgery by 66% of patients [24].…”

Section: Discussionmentioning

confidence: 99%

“…The entity of the improvement in HRQOL observed after LAGB might be only partly explained by the degree of weight loss [7,10,11], and it might also be influenced by preoperative co-morbidities [7] and the interval after surgery [10]. However, LAGB can also cause adverse upper gastrointestinal side effects in some patients [24]. The relative weight of these symptoms (an inability to consume solid foods, moderate dysphagia, occasional regurgitation) on overall patient satisfaction has been reported to be low in a cross-sectional analysis of obese subjects treated with LAGB [24].…”

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confidence: 99%

“…However, LAGB can also cause adverse upper gastrointestinal side effects in some patients [24]. The relative weight of these symptoms (an inability to consume solid foods, moderate dysphagia, occasional regurgitation) on overall patient satisfaction has been reported to be low in a cross-sectional analysis of obese subjects treated with LAGB [24]. However, the role of gastrointestinal side effects in determining postoperative HRQOL after LAGB has never been prospectively analyzed.…”

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confidence: 99%

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Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding

Pilone

Mozzi

Schettino

et al. 2012

Surgery for Obesity and Related Diseases

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Background: We analyzed the health-related quality of life (HRQOL) and its determinants in the first year after laparoscopic adjustable gastric banding (LAGB). The setting was 10 Italian public and private bariatric surgery centers. Methods: Data collected in an ongoing, prospective, 3-year multicenter Italian study on the changes in HRQOL after LAGB were used. HRQOL was investigated using the Medical Outcomes Study ShortForm 36 questionnaire. Hunger, satiety, and the self-perceived effects of LAGB were recorded. Results: A total of 334 patients were enrolled. The follow-up rate was 92.2%. The percentage of excess weight loss was 39.6% Ϯ 25.8%, with very few side effects or complications. Hunger in the morning (0 -10 scale) was 4.5 Ϯ 2.7 before surgery and 3.8 Ϯ 2.4 after 1 year (P Ͻ.001). Satiety after a meal (0 -10 scale) was 7.1 Ϯ 2.7 before surgery and 8.2 Ϯ 1.9 at 1 year (P Ͻ.001). The self-perceived effect of LAGB on caloric intake (0 -10 scale) was 8.4 Ϯ 1.9 after 1 year. The scores for the 8 Medical Outcomes Study Short-Form 36 subscales were significantly improved after surgery. The physical component summary score was 52.6 Ϯ 11.9 at baseline and 79.1 Ϯ 15.6 after 1 year (P Ͻ.001). The corresponding mental component summary scores were 52.2 Ϯ 12.3 and 76.5 Ϯ 17.2 (P Ͻ.001). Greater physical component summary improvement was independently associated with a low initial physical component summary (P Ͻ.001), high satiety (P ϭ .002), a high percentage of excess weight loss (P ϭ .013), and a high self-perceived effect of the LAGB (P ϭ .026). Greater mental component summary improvement was associated with a low initial mental component summary (P Ͻ.001), high satiety (P Ͻ.001), a low frequency of heartburn (P ϭ .004), and a high percentage of excess weight loss (P ϭ .012). Conclusions: Significant improvements in HRQOL were observed in the first year after LAGB. A poor baseline HRQOL, a high efficacy of the banding in eating control, and better weight loss might influence HRQOL changes. (Surg Obes Relat Dis 2012;8:260 -268.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding

Pilone

Mozzi

Schettino

et al. 2012

Surgery for Obesity and Related Diseases

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“…Even stable, successful patients do at times regurgitate foods of an inappropriate bolus consistency. 18 Although these mechanical realities are imposed by the LAGB, whether they are central to the behavioral adaptations, and consequent weight loss remains unclear.…”

Section: Mode Of Weight Loss With Lagbmentioning

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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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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“…24 Burton studied the mechanism of action of the adjustable gastric band, which is considered the model of the restrictive principle. [25][26][27][28][29][30][31] He has accomplished detailed manometric and transit studies to reveal that the band is not restrictive in the sense commonly understood, but may rather induce diminished nutrient intake and weight loss for other reasons.…”

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Collaboration between basic science researchers and bariatric surgeons is a win/win proposition: view from the chair

2011

Int J Obes

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Bariatric surgery in humans offers a window of opportunity to further our understanding of obesity and associated diseases. In the morbidly obese subjects, physiological disturbances are amplified and their extreme manifestations are more easily measured. The significant and predictable effects of bariatric surgery present a striking contrast to preoperative morbid conditions. The bariatric procedure is a reproducible therapy occurring at a precise time point; this facilitates the recording of preoperative and postoperative parameters over a short period of time, with some assurance that the contrasted conditions will confirm or disprove hypotheses with manageable numbers of subjects, thus providing an economy of means and efforts in a shorter time frame.

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Outcomes, Satiety, and Adverse Upper Gastrointestinal Symptoms Following Laparoscopic Adjustable Gastric Banding

Cited by 36 publications

References 18 publications

Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding

Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding

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

Collaboration between basic science researchers and bariatric surgeons is a win/win proposition: view from the chair

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