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Nonsurgical Management of Luminal Dilatation After Laparoscopic Adjustable Gastric Banding

Abstract

Background

Proximal luminal dilatation (PLD) is one of the most significant challenges following laparoscopic adjustable gastric banding (LAGB). If PLD is identified at an early stage, there is potential to avoid reoperation or irreversible change by implementing nonsurgical measures. The success of these strategies is unknown. The aim of this study was to determine the outcome of how often PLD can be successfully treated nonsurgically.

Methods

The records of patients who underwent primary LAGB insertion by a single surgeon from January 2005 to December 2006 were reviewed. Study participants were all patients who had subsequently undergone a postoperative liquid contrast swallow demonstrating a PLD. The severity of PLD, subsequent management, and outcomes were recorded and assessed.

Results

There were 354 patients who underwent a primary LAGB insertion during the study period. Seventy-eight patients were found to have varying degrees of PLD and had an attempt at nonsurgical management. Thirty-four of these patients (43.6 %) were successfully managed nonsurgically at a mean follow-up of 2.8 years (33.2 months, CL ± 3.2). The success with nonsurgical management was lower if the symmetrical pouch dilatation was more severe or gastric prolapse was seen at presentation, and if no improvement in liquid contrast swallow was seen.

Conclusions

PLD can often be successfully managed with nonsurgical measures, maintaining good weight loss in the intermediate term. Patients with more significant dilatation are more likely to require revisional surgery. Early recognition may have a role in preventing surgery or more severe abnormalities.

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Declarations

Paul Burton received a Research Fellowship Grant from the Royal Australasian College of Surgeons to support his research work. Wendy Brown received an Honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009. Paul O’Brien has written a patient information book entitled “The Lap-Band 391 Solution: A Partnership for Weight Loss” which is given to patients without charge, but some are sold to surgeons and others, for which he receives a royalty. He is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility based in Dallas, Texas, that treats obesity predominantly by gastric banding.

Financial Disclosures

The Centre for Obesity Research and Education (CORE) at Monash University receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the protocol, analysis, and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs.

Conflict of Interest

Geraldine Ooi, Paul Burton, Cheryl Laurie, and Geoff Hebbard have no conflict of interest declaration.

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Correspondence to Paul Burton.

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Ooi, G., Burton, P., Laurie, C. et al. Nonsurgical Management of Luminal Dilatation After Laparoscopic Adjustable Gastric Banding. OBES SURG 24, 617–624 (2014). https://doi.org/10.1007/s11695-013-1126-5

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Keywords

  • Proximal luminal dilatation
  • Symmetrical pouch dilatation
  • Gastric prolapse
  • Laparoscopic adjustable gastric banding
  • Bariatric surgery
  • Revision surgery
  • Conservative management
  • Nonsurgical management
  • Complication