Abstract
Surgery for massive super obesity is a formidable challenge. No existing open or laparoscopic procedure reduces BMI below 30 from a starting point above 55. Laparoscopic adjustable gastric banding has been used to treat 76 massive super obese patients with a BMI > 60 kgs/m2. Median weight was 193 kgs +/-34.7 kgs (154–335 kgs). Five patients had a BMI > 100 kgs/m2. There was neither mortality nor pulmonary emboli. hospital stay was 3 days (1–6 days). Excess weight loss was 46.69 +/-10.5 at 1 year; 59.14 +/- 11.7% at 3 years and 61 +/- 15.1% at 5 years. At 2 years, 84% of the patients had greater than 50% excess weight loss and this was maintained at 3, 4, and 5 years. BMI fell from 69 +/- 6.2 to 49 +/- 7.73 at 1 year to 37 +/- 4.45 at 3 years and this was maintained at 4 and 5 years. BMI in 13 patients with > 5 year follow up was 35.09 +/- 53 kgs/m2 (27–44). Weight loss with laparoscopic adjustable gastric banding in this group of massive super obese patients has been similar to all other surgical techniques with reduction of BMI from 69 to 33 kgs/m2 at 3 years. The relative safety of the Lapband avoids bowel surgery in these very big patients, suggesting that laparoscopic adjustable gastric banding is a valid surgical approach to these difficult patients.
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References
JW Allen MG Coleman GA Fielding (2001) ArticleTitleLessons learned from laparoscopic gastric banding for morbid obesity. Am J Surg 182 10–14 Occurrence Handle1:STN:280:DC%2BD3MvovFOgtQ%3D%3D
L Angrisani M Alkitani N Basso et al. (2001) ArticleTitleLaparoscopic Italian experience with the Lapband. Obes Surg 11 307–310 Occurrence Handle1:STN:280:DC%2BD38%2FhslSrtg%3D%3D
B Baltasar R Bou M Bengocha et al. (2001) ArticleTitleDuodenal switch: an effective therapy for morbid obesity—intermediate results. Obes Surg 11 54–58 Occurrence Handle1:STN:280:DC%2BD3M3mvFGjsQ%3D%3D
M Belachew M Legrand V Vincent et al. (1998) ArticleTitleLaparoscopic adjustable gastric banding. World J Surg 22 955–963 Occurrence Handle1:STN:280:DyaK1czotlWnuw%3D%3D
RE Brolin HA Kenler JH German et al. (1992) ArticleTitleLong-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 215 387–395 Occurrence Handle1:STN:280:By2B3MvpvFA%3D
GB Cadiere J Himpens M Vertruyen et al. (2000) ArticleTitleLaparoscopic gastroplasty (adjustable silicone gastric banding) Semin Laparosc Surg 7 55–65 Occurrence Handle1:STN:280:DC%2BD3c3gtVygtA%3D%3D
JF Capella RF Capella (1969) ArticleTitleThe weight reduction operation of choice: vertical banded gastroplasty or gastric bypass. Am J Surg 171 74–79 Occurrence Handle10.1016/S0002-9610(99)80077-4
J Darjent (1999) ArticleTitleLaparoscopic adjustable gastric banding: lessons from the first 500 patients in a single institution. Obes Surg 9 446–452 Occurrence Handle10.1381/096089299765552729 Occurrence Handle1:STN:280:DC%2BD3c%2FntF2itQ%3D%3D Occurrence Handle10605901
EJ DeMaria (2001) ArticleTitleLaparoscopic adjustable silicone gastric banding. Surg Clin North Am 81 1129–1144 Occurrence Handle1:STN:280:DC%2BD3Mrkt1Cjug%3D%3D Occurrence Handle11589249
EJ DeMaria HJ Sugerman MJ Kellum et al. (2001) ArticleTitleHigh failure rate following laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 223 809–818 Occurrence Handle10.1097/00000658-200106000-00011
J Dixon LM Chapman PE O’Brien (1998) ArticleTitleChanges in comorbidities during weight loss after LAPBAND placement. Obes Surg 8 380
JB Dixon PE O’Brien (2002) ArticleTitleHealth outcomes of severely obese type 2 diabetic subject 1 year after laparoscopic adjustable gastric banding. Diabetes Care 25 358–363 Occurrence Handle11815510
F Favourite GG Caddie G Legato et al. (1997) ArticleTitleLaparoscopic adjustable silicone gastric banding (LAPBAND): how to avoid complications. Obes Surg 7 332–358 Occurrence Handle10.1381/096089297765555575 Occurrence Handle9730520
GA Fielding (2000) ArticleTitleReduction in incidence of gastric herniation with LAPBAND—experience in 620 cases. Obes Surg 10 136
GA Fielding M Rhodes LK Nathanson (1999) ArticleTitleLaparoscopic gastric banding for morbid obesity; surgical outcome in 335 cases. Surg Endosc 13 550–554 Occurrence Handle10.1007/s004649901038 Occurrence Handle1:STN:280:DyaK1M3nvVGgtg%3D%3D Occurrence Handle10347288
MM Gagner (1999) ArticleTitleLaparoscopic biliopancreatic diversion with duodenal switch. Technique and preliminary results. Surg Endosc Suppl 19–26
M Gagner A Garcia-Ruiz MJ Arca T Hannaford (1999) ArticleTitleLaparoscopic isolated gastric bypass for morbid obesity. Surg Endosc S19–S26
RJ Greenstein L Martin K MacDonald et al. (1999) ArticleTitleThe LAPBAND system as surgical therapy for morbid obesity intermediate results of the USA multicenter, prospective study. Surg Endosc 13 S1–S18 Occurrence Handle10.1007/s004649900885 Occurrence Handle10333873
KD Higa KB Boone T Ho (2000) ArticleTitleComplications of the laparoscopic Roux-en-Y gastric bypass; 1040 patients—what have we learned? Obes Surg 10 509–513 Occurrence Handle10.1381/096089200321593706 Occurrence Handle1:STN:280:DC%2BD3M7ks1WjtQ%3D%3D Occurrence Handle11175957
KD Higa K Boone T Ho OG Davies (2000) ArticleTitleLaparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135 1029–1033 Occurrence Handle1:STN:280:DC%2BD3cvmtF2luw%3D%3D
A Jr Igwe M Stabczyk H Lee et al. (2000) ArticleTitlePanniculectomy adjuvant to obesity surgery. Obes Surg 10 530–539 Occurrence Handle10.1381/096089200321593742 Occurrence Handle11175961
JM Kellum EJ DeMaria HJ Sugerman (1998) ArticleTitleThe surgical treatment of morbid obesity. Curr Problems Surg 35 796–851
LD MacLean RM Rhode RA Forse (1990) ArticleTitleLate results of vertical banded gastroplasty for morbid obesity and super obesity. Surgery 104 20–27
LD MacLean B Rhode CW Nohn (2000) ArticleTitleLate outcome of isolated gastric bypass. Ann Surg 231 524–528 Occurrence Handle10.1097/00000658-200004000-00011 Occurrence Handle1:STN:280:DC%2BD3c3htlaitQ%3D%3D Occurrence Handle10749613
P Marceau PS Hold S Simmered et al. (1998) ArticleTitleBiliopancreatic diversion with duodenal switch. World J Surg 22 947–954 Occurrence Handle10.1007/s002689900498 Occurrence Handle1:STN:280:DyaK1czotlWnug%3D%3D Occurrence Handle9717420
MM Murr BM Balsiger FP Kennedy JL Mai MG Sarr (1999) ArticleTitleMalabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very, very long limb Roux-en-Y gastric bypass. J Gastrointest Surg 3 607–612 Occurrence Handle10.1016/S1091-255X(99)80082-1 Occurrence Handle1:STN:280:DC%2BD3c%2FitF2qsg%3D%3D Occurrence Handle10554367
NT Nguyen C Goldman CJ Rosenquist et al. (2001) ArticleTitleLaparoscopic versus open gastric bypass: a randomized study of outcomes of life and costs. Ann Surg 234 279–291 Occurrence Handle10.1097/00000658-200109000-00002 Occurrence Handle1:STN:280:DC%2BD3MvotVymtA%3D%3D Occurrence Handle11524581
NT Nguyen HS Ho LS Palmer BM Wolf (1999) ArticleTitleLaparoscopic Roux-en-Y gastric bypass for super/super obesity. Obes Surg 9 403–406 Occurrence Handle10.1381/096089299765553025 Occurrence Handle1:STN:280:DyaK1Mvht1WgsA%3D%3D Occurrence Handle10484302
PE O’Brien W Brown J Dixon (2001) ArticleTitleRevisional surgery for morbid obesity — conversion to the LAPBAND system. Obes Surg 11 731–734 Occurrence Handle10.1381/09608920160558678 Occurrence Handle11775571
PE O’Brien A Brown PJ Smith et al. (1999) ArticleTitleProspective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 85 113–118 Occurrence Handle10.1046/j.1365-2168.1999.00964.x
D Peternac R Hauser M Weber O Schob (2001) ArticleTitleThe effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus. Obes Surg 11 76–86 Occurrence Handle10.1381/096089201321454150 Occurrence Handle1:STN:280:DC%2BD3M3mvFGjtQ%3D%3D Occurrence Handle11361173
WJ Pories MS Swanson KG MacDonald et al. (1995) ArticleTitleWho would have thought it: an operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222 339–350 Occurrence Handle1:STN:280:ByqH3cjps1I%3D Occurrence Handle7677463
CJ Ren E Patterson MM Gagner (2000) ArticleTitleEarly results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10 514–523 Occurrence Handle10.1381/096089200321593715 Occurrence Handle1:STN:280:DC%2BD3M7ks1Wjug%3D%3D Occurrence Handle11175958
JA Sapala MH Wood MA Sapala et al. (2001) ArticleTitleThe micropouch gastric bypass: technical considerations in primary and revisionary operations. Obes Surg 11 3–17 Occurrence Handle10.1381/096089201321454042 Occurrence Handle1:STN:280:DC%2BD3M3mvFCquw%3D%3D Occurrence Handle11361165
PR Schauer S Ikramuddin W Gourash et al. (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1eitA%3D%3D Occurrence Handle10998650
M Taskin K Zenmgin E Unal N Sakoglu (2001) ArticleTitleConversion of failed vertical banded gastroplasty to open adjustable gastric banding. Obes Surg 11 731–734 Occurrence Handle10.1381/09608920160558678 Occurrence Handle11775571
R Weiner D Wagner J Bockhorn (1999) ArticleTitleLaparoscopic gastric banding for morbid obesity. J Laparoendosc Adv Surg Tech 9 23–30
AC Wittgrove GW Clark (2000) ArticleTitleLaparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results with 3–60 month follow-up. Obes Surg 10 233–239 Occurrence Handle1:STN:280:DC%2BD3cvotFOlsQ%3D%3D Occurrence Handle10929154
JM Zimmerman M Blank JMG Zimmerman (2000) ArticleTitleSlippage, a major problem of gastroplastic surgery by L.A.S.G.B. How to treat it and how to prevent it relating to homogenous series of 82 patients out of 1050 L.A.S.G.B. operated between July 95 and July 99. Obes Surg 10 135
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Fielding, G. Laparoscopic adjustable gastric banding for massive superobesity ( > 60 body mass index kg/m2) . Surg Endosc 17, 1541–1545 (2003). https://doi.org/10.1007/s00464-002-8921-8
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DOI: https://doi.org/10.1007/s00464-002-8921-8