PURPOSE: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. MATERIALS AND METHODS: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. RESULTS: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. CONCLUSION: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
Adult ; Female ; Gastroplasty/adverse effects/*methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid/*surgery ; Postoperative Complications ; Treatment Outcome

OBJECTIVETo investigate the diagnosis and treatment of the complications in patients after laparoscopic adjustable gastric banding (LAGB) procedure.

METHODSRetrospectively analyze the data of the 23 patients who received the LAGB procedure from June 2003 to November 2004.

RESULTSOf the 23 LAGB operations, 3 (13%) cases of vomiting and nausea, 1 (4.3%) case of access-port infection and 5 (21.4%) cases of food intolerance occurred. One band (4.3%) and one injection reservoir (4.3%) displaced and were removed by laparoscopy. No death and thrombo-embolism occurred.

CONCLUSIONSThe diagnosis and treatment of complications after LAGB in morbid obesity was special, if managed properly, the result would be satisfactory.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Gastroplasty ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Obesity, Morbid ; surgery ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Retrospective Studies

Esophageal perforation after endoscopic forceful pneumatic dilatation for achalasia is a devastating complication and surgical treatment is necessary. A 65-yr-old man and a 54-yr-old woman referred for esophageal perforation two hours after pneumatic dilatation and during the procedure, respectively. Gastroplasties through thoracotomy were performed in both cases and their recoveries were uneventful. The esophagogram with gastrografin on the post-operative 8th day did not show any passage disturbance or leakage at the anastomosis site. On the follow-up endoscopy 4 to 6 months after operation revealed that reflux esophagitis of LA classification A were noted in the both patients. They did not complain any reflux symptom or dysphagia for 9 to 13 months after operation. Instead of the most widely used procedure; primary repair of perforation site, wrapping with intercostal muscle flap and esophagomyotomy, gastroplasty was performed in two cases of iatrogenic esophageal perforation in achalasia and experienced good results.
Aged ; Deglutition Disorders/complications ; Endoscopy, Gastrointestinal/*adverse effects ; Esophageal Achalasia/*surgery ; Esophageal Perforation/*surgery ; Esophagus/*surgery ; Female ; Gastroesophageal Reflux/complications ; Gastroplasty/*methods ; Humans ; Male ; Middle Aged ; Thoracotomy

The emerging endoscopic technologies are proved to be effective treatments for obesity in selected patients and to offer the potential advantages of reduced invasiveness, reversibility and repeatability. From the view of operation principle, endoscopic technologies can be classified as restrictive procedure, malabsorption procedure and endoscopic revision of gastric bypass. Restrictive procedures include intragastric balloon, aspiration therapy, endoscopic sleeve gastroplasty (ESG) and transoral gastroplasty. Intragastric balloon employs space occupying, volume restriction and satiety mechanisms, which is superior to drugs and lifestyle change, but shorter than sleeve and bypass surgery. Aspiration therapy is similar to standard percutaneous endoscopic gastrostomy, while there are no available data regarding the obesity and metabolic improvement. Compared with traditional bariatric surgery, ESG does not excise gastric tissue with less complications and without weight regain, but it can not be used as an independent operation still now. Transoral gastroplasty is rarely applied clinically whose efficacy and long-term complications need further studies. Malabsorption surgery includes endoscopic duodenojejunal bypass sleeve (EDJBS) and endoscopic gastroduodenojejunal bypass sleeve(EGDJBS). EDJBS may have the similar mechanism like bypass reducing the blood glucose. Even with obvious effect of weight loss, EDJBS has high morbidity of complications and requirements of the skilled operators. EGDJBS, which imitates bypass anatomy changes and belongs to the mixed operation, should be superior to the above procedures in reducing weight theoretically, but due to the lack of clinical data, its short-term and long-term efficacy still need further clinical observation. As compared to the complexity and risks associated with telescopic surgical revision, endoscopic suturing has been confirmed as less invasive and safer for stomal revisions, while its long-term efficacy of reducing weight and improvement of diabetes are not yet clear. Even if long-term efficacy of reducing weight and morbidity of complication in endoscopic bariatric surgery are still indefinite, and clinical trial researches of large sample and long-term follow-up are absent, with the development of endoscopic skill and the gradual clinical application, endoscopic bariatric surgery will provide a new option for the patients of obesity and metabolic diseases.
Bariatric Surgery ; adverse effects ; methods ; statistics & numerical data ; trends ; Disease Management ; Endoscopy ; adverse effects ; methods ; statistics & numerical data ; Gastric Balloon ; statistics & numerical data ; Gastric Bypass ; adverse effects ; methods ; statistics & numerical data ; Gastroplasty ; adverse effects ; methods ; statistics & numerical data ; Humans ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Reoperation ; adverse effects ; methods ; statistics & numerical data ; Surgical Stomas ; pathology ; statistics & numerical data ; Treatment Outcome ; Weight Loss

PURPOSE: The aim of this study was to compare short-term outcomes [food tolerance scores (FTS) and quality of life] after three types of restrictive bariatric surgery: laparoscopic adjustable gastric banding (LAGB), laparoscopic greater curvature plication (LGCP), and laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: From January 2012 to December 2013, all patients that underwent primary surgery were included in one of the LAGB, LGCP, or LSG groups. These three groups were then compared with respect to FTS, gastrointestinal quality of life indices (GIQLI), and the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire. Questionnaires were sent to all patients both pre- and post-operatively. RESULTS: A total of 85 patients (LAGB=45, LGCP=22, and LSG=18) returned the questionnaires in full, and these patients constituted the study cohort. The cohort was predominately female (n=73, 85.9%). Mean percentage excess weight loss (%EWL) values after LAGB, LGCP, and LSG were 65.4+/-27.0%, 65.6+/-25.2%, and 82.7+/-21.7%, respectively (p=0.044). Mean postoperative FTSs and improvements in total GIQLIs after LAGB, LGCP, and LSG were 15.96, 20.95, and 21.33 and -3.40, 6.68, and 18.78, respectively (p<0.05). All procedures produced improvements in the three SF-36 domain scores. Subgroup analysis revealed significant differences between the three procedures in terms of improvements in general health and emotional well-being. CONCLUSION: LGCP is safe and effective at achieving significant weight loss. In terms of food tolerance and GI quality of life, LGCP was found to be comparable to gastric banding and sleeve gastrectomy.
Adult ; Cohort Studies ; Female ; Gastrectomy/*methods ; Gastroplasty/adverse effects/*methods ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Obesity, Morbid/psychology/*surgery ; Postoperative Complications/epidemiology ; Postoperative Period ; *Quality of Life ; Surveys and Questionnaires ; Treatment Outcome ; Weight Loss ; Young Adult

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.
Anemia ; epidemiology ; Bariatric Surgery ; adverse effects ; methods ; statistics & numerical data ; Biliopancreatic Diversion ; adverse effects ; methods ; statistics & numerical data ; Body Mass Index ; Comorbidity ; Contraindications ; Diabetes Mellitus ; surgery ; Disease Management ; Gastrectomy ; adverse effects ; methods ; statistics & numerical data ; Gastric Bypass ; adverse effects ; methods ; statistics & numerical data ; Gastroesophageal Reflux ; Gastroplasty ; methods ; mortality ; statistics & numerical data ; Humans ; Informed Consent ; Laparoscopy ; adverse effects ; methods ; statistics & numerical data ; Long Term Adverse Effects ; epidemiology ; Malnutrition ; epidemiology ; Obesity ; surgery ; Patient Acuity ; Patient Care Planning ; Patient Compliance ; Postgastrectomy Syndromes ; epidemiology ; Postoperative Complications ; epidemiology ; Risk Assessment ; methods ; Risk Factors ; Stomach Neoplasms ; epidemiology ; Treatment Outcome ; Weight Loss