Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity

O'Brien, Paul Edmond; Brown, Wendy A.; Smith, Andrew; McMurrick, Paul; Stephens, M.M.

doi:10.1046/j.1365-2168.1999.00964.x

Cited by 293 publications

(156 citation statements)

References 17 publications

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“…Laparoscopic gastric banding has been shown to be safe and effective in the surgical treatment of morbid obesity [3,4]. Several experiences with different lengths of followup have confirmed that band positioning has lower mortality and complication rate as compared with other more invasive procedures [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Several experiences with different lengths of followup have confirmed that band positioning has lower mortality and complication rate as compared with other more invasive procedures [1][2][3][4]. Over the years, different technical variations have been proposed, all having different impacts on the technical improvement of band positioning and its results.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…13 The ®nding of high homocysteine levels at the end of the second year when the rate of weight loss is usually low is important. This con®rms the need for continued nutritional monitoring and supplementation even when the rate of weight loss falls with time.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure creates an early sense of satiety after eating and has been shown to be safe and effective. 13 Patients with a body mass index (BMI) greater than 35 kgam 2 , suffering signi®cant medical, physical or psychosocial disabilities and who have attempted weight reduction by other means for at least 5 y are considered for entry into the Lap-Band program. Pre-operative assessment includes measurement of hemoglobin and red cell indices, iron studies, serum vitamin B 12 , serum folate, red-cell folate and fasting plasma total homocysteine.…”

Section: Study Subjectsmentioning

confidence: 99%

Elevated homocysteine levels with weight loss after Lap-Band® surgery: higher folate and vitamin B12 levels required to maintain homocysteine level

Dixon

O'Brien

2001

Int J Obes

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OBJECTIVE:To investigate homocysteine levels and their relationship with serum folate and vitamin B 12 concentrations with weight loss after the Lap-Band 1 form of gastric restrictive surgery, with the view to minimizing risk. METHODS: We measured levels of fasting plasma homocysteine (tHcy), folate (serum and RBC) and vitamin B 12 in two groups. The study group was 293 consecutive patients at 12 (n 192) or 24 (n 101) months review after surgery. The controls were 244 consecutive patients presenting for this surgery. RESULTS: The group losing weight had higher geometric mean tHcy levels: 10.4 (95% CI, 9.8 ± 10.8) mmolal compared with 9.2 (95% CI, 8.9 ± 9.7) in controls (P`0.001). This occurred with higher folate levels and unchanged vitamin B 12 levels. Levels of folate and B 12 together explained 35% (r 2 ) of the homocysteine variance in the weight loss group compared with only 9% (r 2 ) in controls (P`0.001). Those taking regular multivitamin supplements had lower tHcy levels: 9.6 (9.1 ± 10.0) mmolal vs 12.3 (11.4 ± 13.3) in those not taking supplements (P`0.001). A low normal plateau of tHcy levels occurred at levels of folate b15 ngal and B 12 b600 ngaml. A curvilinear relationship exists between these cofactors and tHcy levels, with the dose ± response relationship shifted to the right in the weight loss group. CONCLUSION: This study shows elevated tHcy levels with weight loss, without lower serum folate or vitamin B 12 levels. There is an altered dose ± response relationship with higher serum B 12 and folate levels required to maintain recommended tHcy levels. Patients losing weight have signi®cant health bene®ts; however, they may be at greater risk of vascular events or fetal abnormality in association with raised tHcy levels. Multivitamin supplementation is effective in lowering tHcy levels.

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“…1 It is one of the most powerful medical interventions available. 2,3 It induces and maintains a substantial weight loss. 4 However, despite widespread use, there is only limited understanding of how the LAGB achieves this weight loss.…”

Section: Introductionmentioning

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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Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity

Cited by 293 publications

References 17 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

Elevated homocysteine levels with weight loss after Lap-Band® surgery: higher folate and vitamin B12 levels required to maintain homocysteine level

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

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