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Obesity Surgery

, Volume 19, Issue 2, pp 146–152 | Cite as

Radiological Assessment of Complications After Laparoscopic Suprabursal Adjustable Gastric Banding for Morbid Obesity

  • Fabio PomerriEmail author
  • Mirto Foletto
  • Paolo Bernante
  • Elisa Tonello
  • Pier Carlo Muzzio
Research Article

Abstract

Background

The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss.

Methods

Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up.

Results

There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases.

Conclusion

Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.

Keywords

Radiology Morbid obesity Laparoscopy Adjustable gastric banding Gastric slippage 

References

  1. 1.
    Cadiere GB, Bruyns J, Himpens J, et al. Laparoscopic gastroplasty for morbid obesity. Br J Surg 1994;81:1524–25.CrossRefGoogle Scholar
  2. 2.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding: technique and results. Obes Surg 1995;5:364–71.CrossRefGoogle Scholar
  3. 3.
    Belachew M, Legrand MJ, Defechereux TH, et al. Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity. A preliminary report. Surg Endosc 1994;8:1354–56.CrossRefGoogle Scholar
  4. 4.
    Belachew M, Legrand M, Vincent V, et al. Laparoscopic adjustable gastric banding. World J Surg 1998;22:955–63.CrossRefGoogle Scholar
  5. 5.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications. Obes Surg 1997;7:352–8.CrossRefGoogle Scholar
  6. 6.
    Fielding GA, Allen JW. A step-by-step guide to placement of the LAP-BAND adjustable gastric banding system. Am J Surg 2002;184(6B):26S–30S.CrossRefGoogle Scholar
  7. 7.
    Zappa MA, Micheletto G, Lattuada E, et al. Prevention of pouch dilatation after laparoscopic adjustable gastric banding. Obes Surg 2006;16:132–6.CrossRefGoogle Scholar
  8. 8.
    Hainaux B, Agneessens E, Rubesova E, et al. Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication. Am J Roentgenol 2005;184:109–12.CrossRefGoogle Scholar
  9. 9.
    Nocca D, Frering V, Gallix B, et al. Migration of adjustable gastric banding from a cohort study of 4236 patients. Surg Endosc 2005;19:947–50.CrossRefGoogle Scholar
  10. 10.
    Wölnerhanssen B, Kern B, Peters T, et al. Reduction in slippage with 11-cm Lap-Band and change of gastric banding technique. Obes Surg 2005;15:1050–4.CrossRefGoogle Scholar
  11. 11.
    Chevallier JM, Zinzindohoué F, Douard R, et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg 2004;14:407–14.CrossRefGoogle Scholar
  12. 12.
    Blanco-Engert R, Weiner S, Pomhoff I, et al. Outcome after laparoscopic adjustable gastric banding, using the Lap-Band and the Heliogast band: a prospective randomized study. Obes Surg 2003;13:776–9.CrossRefGoogle Scholar
  13. 13.
    Pomerri F, De Marchi F, Barbiero G, et al. Radiology for laparoscopic adjustable gastric banding: a simplified follow-up examination method. Obes Surg 2003;13:901–8.CrossRefGoogle Scholar
  14. 14.
    Susmallian S, Ezri T, Elis M, et al. Access-port complications after laparoscopic gastric banding. Obes Surg 2003;13:128–31.CrossRefGoogle Scholar
  15. 15.
    Favretti F, Cadière GB, Segato G, et al. Laparoscopic banding: selection and technique in 830 patients. Obes Surg 2002;12:385–90.CrossRefGoogle Scholar
  16. 16.
    Zacharoulis D, Roy-Chadhury SH, Dobbins B, et al. Laparoscopic adjustable gastric banding: surgical and radiological approach. Obes Surg 2002;12:280–4.CrossRefGoogle Scholar
  17. 17.
    Frigg A, Peterli R, Zynamon A, et al. Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 2001;11:594–9.CrossRefGoogle Scholar
  18. 18.
    Mortelé KJ, Pattijn P, Mollet P, et al. The Swedish laparoscopic adjustable gastric banding for morbid obesity: radiologic findings in 218 patients. Am J Roentgenol 2001;177:77–84.CrossRefGoogle Scholar
  19. 19.
    Carucci LR, Turner MA, Szucs RA. Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications. Radiol Clin North Am 2007;45:261–74.CrossRefGoogle Scholar
  20. 20.
    Blachar A, Blank A, Gavert N, et al. Laparoscopic adjustable gastric banding surgery for morbid obesity: imaging of normal anatomic features and postoperative gastrointestinal complications. Am J Roentgenol 2007;188:472–9.CrossRefGoogle Scholar
  21. 21.
    Roy-Choudhury SH, Nelson WM, El Cast J, et al. Technical aspects and complications of laparoscopic banding for morbid obesity—a radiological perspective. Clin Radiol 2004;59:227–36.CrossRefGoogle Scholar
  22. 22.
    Nehoda H, Hourmont K, Mittermair R, et al. Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory? Obes Surg 2001;11:600–4.CrossRefGoogle Scholar
  23. 23.
    Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003;13:159–60.CrossRefGoogle Scholar
  24. 24.
    Peternac D, Hauser R, Weber M, et al. The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus. Obes Surg 2001;11:76–86.CrossRefGoogle Scholar
  25. 25.
    Belachew M, Zimmermann JM. Evolution of a paradigm for laparoscopic adjustable gastric banding. Am J Surg 2002;184(6B):21S–5S.CrossRefGoogle Scholar
  26. 26.
    Spivak H, Favretti F. Avoiding postoperative complications with the LAP-BAND system. Am J Surg 2002;184(6B):31S–7S.CrossRefGoogle Scholar
  27. 27.
    Foletto M, De Marchi F, Bernante P, et al. Late gastric pouch necrosis after Lap-Band, treated by an individualized conservative approach. Obes Surg 2005;15:1487–90.CrossRefGoogle Scholar
  28. 28.
    O’Brien PE, Dixon JB, Laurie C, et al. A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg 2005;15:820–6.CrossRefGoogle Scholar
  29. 29.
    Bernante P, Francini Pesenti F, Toniato A, et al. Obstructive symptoms associated with the 9.75-cm Lap-Band in the first 24 hours using the pars flaccida approach. Obes Surg 2005;15:357–60.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Fabio Pomerri
    • 1
    • 3
    Email author
  • Mirto Foletto
    • 2
  • Paolo Bernante
    • 2
  • Elisa Tonello
    • 1
  • Pier Carlo Muzzio
    • 1
    • 3
  1. 1.Department of Medical-Diagnostic Sciences and Special Therapies, RadiologyUniversity of PaduaPaduaItaly
  2. 2.2nd Institute of Clinical SurgeryUniversity of PaduaPaduaItaly
  3. 3.The Veneto Institute of Oncology (IOV-IRCCS)PaduaItaly

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