Long-term results after laparoscopic adjustable gastric banding in adolescent patients: follow-up of the Austrian experience.

BACKGROUND: During the last 30 years a threefold increase in the number of overweight children has been reported in Western countries. More than 15% of adolescents have a body mass index (BMI) higher than the 95th percentile. The use of surgical strategies in adolescent patients is still controversial due to the impact on the continuing maturing process. Laparoscopic adjustable gastric banding (LAGB) is considered a minimal invasive procedure that does not alter the physiological behavior of the bowel and has already shown promising results in short-term studies. METHODS: Between 1998 and 2004, 50 adolescent patients above the 99.5th age- and gender-adjusted growing percentile were treated with LAGB. The surgical procedure was performed at three highly experienced centers for bariatric surgery. Mean age was 17.1 ± 2.2 years (range = 9-19 years) at the time of surgery. Follow-up investigations were performed in the outpatient clinic of the treating hospitals. Psychological changes were analyzed using the BAROS questionnaire. RESULTS: The mean BMI decreased from 45.2 ± 7.6 kg/m(2) at the time of surgery to 38.3 ± 6.2 kg/m(2) 1 year after surgery, 31.5 ± 6.6 kg/m(2) after 3 years, and 27.3 ± 5.3 kg/m(2) after 5 years. Mean excessive weight loss was 49.7 ± 29.2, 76.8 ± 27.5, and 92.6 ± 24.5% at 1, 3, and 5 years after surgery. Quality of life showed a further significant improvement between 3 and 5 years after surgery (BAROS: 5.5 ± 1.9 increased to 6.3 ± 2.2, p = 0.01). All preoperative comorbidities resolved in patients with a functional band after 5 years of follow-up. CONCLUSION: LAGB shows promising results in the long-term follow-up with continuous weight loss in patients with a functional band. Nevertheless, most of the weight loss is within the first 3 years after surgery. Thereafter, further weight reduction is about 10% over the following 2 years. Perioperative comorbidities resolve within the first 5 years after treatment.

Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study.

BACKGROUND: Laparoscopic adjustable gastric band port placement can require 9-25% of total implantation time. Prolonged port fixation combined with extended wound manipulation results in an elevated incidence of port-related complications (infection, port tension, pain, rotation). This study compared port fixation using a novel applier to traditional fixation using nonresorbable sutures. METHODS: From Dec 2005 to March 2006, 50 patients were enrolled into a prospective randomized study. Intra- and postoperative outcomes of placing the Swedish Adjustable Gastric Band((R)) (SAGB) Realize with Velocity port and fixation device (group A) were compared to those of the SAGB with its titanium suture-fixation port (group B). Patient characteristics, port implantation duration, incision length, postoperative port-site pain [via visual analogue scale (VAS)], pain medication, and complications were recorded. Minimum follow-up was 12 months (three visits). Postoperative evaluation was performed by an investigator not involved in the surgery. RESULTS: Patient groups were comparable in age, sex, and body mass index. In group A versus group B, mean port implantation time was lower (53.5 +/- 13.1 versus 451.3 +/- 84.9 s, p < 0.0001), port-site skin incision was longer (mean 4.1 +/- 0.2 versus 3.1 +/- 0.2 cm, p < 0.0001), and postoperative opioid consumption was less (mean 1.3 versus 3.0 units, p < 0.01). Group A reported less mean pain on the VAS (3.2 versus 3.8, p < 0.01); 0/25 group A versus 3/25 group B patients required hypnotics. There were no discernible differences between groups in hospitalization (mean 2.9 days), nursing requirements, or pain at 3, 6, and 12 months. In group A, no patient required reoperation for a port complication; two port rotations occurred in group B (NS). CONCLUSION: Velocity mechanical port applier fixation is superior in efficiency to port suture fixation, safely increasing the speed to port implant from nearly 8 min to under 1 min and decreasing total operative time by 19%. Port applier fixation trends to reduction of major complications and statistically significantly lessens the minor complication of port-site pain.

Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial.

BACKGROUND: Staple line failure, although uncommon, can result in significant morbidity and, even, mortality. Staple line buttressing has been developed to improve staple line strength, decrease bleeding, and minimize the risk of leak. Many different products are currently available. However, most have not been proved in clinical trials for their clinical relevance. METHODS: From April 2004 to March 2005, 48 morbidly obese patients who had undergone laparoscopic Roux-en-Y gastric bypass were enrolled in this study. The patients were randomly allocated to 2 groups according to whether polyglycolide acid and trimethylene carbonate (Seamguard) was (group 1, n = 24) or was not (group 2, n = 24) used in an investigator-initiated study. All patients underwent barium radiography at 3 and 12 months postoperatively. RESULTS: Peri- and postoperative mortality were absent. The intraoperative methylene blue test was positive in 1 patient in group 2. No conversion to laparotomy was needed. No patient required reoperation or transfusion for extraluminal bleeding, and no anastomotic leaks were detected in either group postoperatively. The mean number of clip instruments used was significantly lower in group 1 patients (2 versus 22, P <.0001, odds ratio 121.0, 95% confidence interval 12.5-1491). The operative time was significantly less in group 1 (115 +/- 30.0 min, range 85-210) compared with that in group 2 (150 +/- 51.7 min, range 90-240; P <.05). The postoperative hemoglobin level was significantly greater in group 1 (12.47 +/- 1.7 mg/dL, range 9.2-14.8) compared with that in group 2 (11.1 +/- 1.9 mg/dL, range 8.1-14.6; P <.05). Gastrogastric fistula formation was detected in 3 patients (12.5%) in group 2, with no statistically significant difference (P = .2). CONCLUSION: The results of our study have shown that synthetic reinforcement material minimizes staple line bleeding and reduces the operative time, with no animal source contamination. No adverse events related to the resorbable buttressing material were observed.

Laparoscopic adjustable gastric banding in adolescents: the Austrian experience.

BACKGROUND: Morbid obesity is a rising problem in adolescents in the industrial nations. Up to 25% of children have a body mass index (BMI) higher than the 85th age- and sex-adjusted percentile. Obesity in youth is associated with increased risk for morbidity and mortality in adulthood. In addition, these patients suffer from psychological problems and decreased quality of life. Bariatric procedures have shown effective long-term results in adults, but they are still discussed controversially in adolescent patients. METHODS: Between 1998 and 2004, 50 adolescent patients with a mean age of 17.1+/-2.2 years (range 9-19 years) underwent laparoscopic adjustable gastric banding (LAGB) in Austria. The psychological changes were analyzed by using Moorehead-Ardelt/BAROS questionnaire. RESULTS: The mean BMI decreased from 45.2+/-7.6 kg/m2 at time of surgery to 32.6+/-6.8 kg/m2 after a mean follow-up of 34.7+/-17.5 months. The mean excess weight loss was 61.4+/-35.5%. Most of the adolescents showed remarkable improvements in their quality of life. The outcome was regarded as "excellent or very good" in 32 patients, "good" in 12 patients and "fair" in 5 patients. Only one patient noticed no alterations after surgery. Two-thirds of the preoperative co-morbidities resolved, and one-third improved during follow-up. Except for one port dislocation, no peri- or postoperative complications arose. CONCLUSION: LAGB is an effective and attractive treatment option in very carefully selected obese adolescents, because of its adjustability and the preservation of the gastrointestinal passage. The majority of patients showed a remarkable improvement in their quality of life.