Fixation of the access-port is not required in gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is increasingly performed in patients with morbid obesity. Suturing of the access-port in LAGB can be difficult and time consuming but is felt necessary by many surgeons to prevent migration and facilitate band adjustments. METHODS: Between 2003 and 2006, 226 patients underwent LAGB with the MIDband. All surgery was performed by the pars flaccida approach. The access-port was positioned in a subcutaneous pouch adjacent to the left hypochondrial port site and was not secured. Regular follow-up and band fills were offered. All band or port-related complications were duly recorded. A patient satisfaction survey was also conducted among 50 randomly selected post-banding patients. RESULTS: Mean age was 41.65 years (range 18-73 years) and mean BMI was 45.85 kg/m2 (range 34.0-74.93 kg/m2). The access-port was inaccessible at first attempt in 5 (2%) patients. 4 of these required radiological imaging to identify the port orientation and 1 required multiple attempts at port puncture with subsequent re-operation due to tube puncture. 91% of patients reported no significant trouble other than mild discomfort and prominence of the port. CONCLUSION: This study shows non-fixation of the access-port to be safe and effective with good patient acceptability. In addition, it avoids the need for regular X-ray localization of the port.

The Impact of Laparoscopic Adjustable Gastric Banding on an NHS Cohort of Type 2 Diabetics: a Prospective Cohort Study.

BACKGROUND: Obesity is an independent risk factor for diabetes, which is associated with significant morbidity and premature death. This study aims to evaluate the impact of laparoscopic adjustable gastric banding (LAGB) on a cohort of morbidly obese diabetics. METHODS: Inclusion and exclusion criteria were applied to consecutive diabetic patients undergoing LAGB. Demographic and disease-specific data were collected at baseline and 6-monthly intervals corresponding to follow-up assessments. Minimum follow-up was 24 months. Normally distributed variables were assessed with one-way analysis of variance/t tests; proportions were analysed with chi-squared/Fisher's exact tests. Follow-up was ≥90 % complete at each time point. RESULTS: One hundred twenty patients with a median age of 43.3 years, mean (± standard deviation (SD)) pre-op body mass index (BMI) of 48.7 (±8) kg/m2, and HbA1c of 8.6 (±2) % were included. BMI reduced significantly, with annual post-operative means of 41.4 ± 7.8, 39.9 ± 7.7, 39.5 ± 7.8, 39.3 ± 7.1 and 36.6 ± 5.4 kg/m(2) (p < 0.001). Corresponding percentage excess body weight lost was 32.8 ± 18, 39.8 ± 21.4, 38.5 ± 21.3, 37.0 ± 22.3 and 43.1 ± 14.1 %. HbA1c was significantly lower at each time point until 30 months post-operatively (p < 0.001). Thereafter, differences were insignificant, and HbA1c was comparable to pre-operative levels by 5 years. Seventy-six (63 %) patients achieved an HbA1c <7 % at 30 months (p < 0.001). Twenty-six (23 %) patients achieved remission from diabetes. The cumulative 5-year cost saving from reductions in anti-diabetes medications was £1650/patient. There were no mortalities, and 18 device explants. CONCLUSIONS: Modest but durable weight loss associated with significant improvements in glycaemic control and anti-diabetic medication use have been demonstrated. Peak effects occur within 24-30 months and diminish thereafter, possibly reflecting progression of pathological processes due to residual obesity.

Ethnic minorities have equal access to bariatric surgery in the UK and Ireland.

Under-representation of ethnic minority groups in bariatric surgery rates has been reported in the USA. Ethnic minorities form 7.9 % of the UK population, but comparable data on provision of bariatric surgery for these groups have not previously been reported in the UK. We calculated an estimate of rates of bariatric surgery amongst ethnic groups in the UK and Ireland using data from the National Bariatric Surgery Registry and census data from the UK and Ireland. The number of procedures recorded per 1,000 morbidly obese patients was 5.2 for Caucasian patients, 5.2 for Asian patients and 5.2 for Black patients. The identical rates across different ethnic groups suggest that bariatric services are provided equitably in the UK, with ethnic minority groups achieving equal access.

The effects of laparoscopic adjustable gastric banding on idiopathic intracranial hypertension.

The purpose of this study was to determine whether laparoscopic adjustable gastric banding has a role in the treatment of idiopathic intracranial hypertension. This pilot study was undertaken in a single, tertiary referral centre. Data on all patients with idiopathic intracranial hypertension that have undergone laparoscopic adjustable gastric banding in our unit were collected from our prospectively maintained bariatric database. Additional information was obtained via telephone questionnaires and review of medical records. Four female patient with a mean age of 32 years (range 29-39 years) and mean pre-operative body mass index of 46.1 kg/m(2) (range 38.2-54.0 kg/m(2)) underwent laparoscopic adjustable gastric banding between June 2006 and July 2009. At a mean follow-up of 19.8 months all four patients reported either total resolution of headache or significant improvement in headache, with a mean improvement in pain score of 76.3/100 (range 55-95) on a analogue pain score. Mean excess weight loss at follow-up was 64.1% (range 50.1-88.2%). There were no complications or mortality in this cohort. This study suggests that laparoscopic adjustable gastric banding represents an effective and safe treatment for idiopathic intracranial hypertension associated with morbid obesity. We have shown good results both in terms of symptom resolution and weight loss, whilst avoiding alimentary tract diversion procedures in these young female patients. A randomized, controlled trial can be justified on the basis of this initial pilot study.

The reporting of gastric band slip and related complications; a review of the literature.

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.

The use of porcine dermal collagen implants in assisting abdominal wall closure of pediatric renal transplant recipients with donor size discrepancy.

Children may have kidneys transplanted from donors larger than themselves. Abdominal wall closure may be difficult, with risks of abdominal compartment syndrome and graft compromise. Meshes used to facilitate closure may cause dense intra-abdominal adhesions, making further surgery or peritoneal dialysis difficult. We present five cases in which abdominal wall closure was facilitated by porcine dermal collagen implant. Five children (2-15 yr) received transplanted kidneys from adult donors of significantly greater weight. In four recipients, the kidney was transplanted onto the aorta and vena cava intra-abdominally using a midline incision. In the fifth, the kidney was anastomosed onto the iliac vessels. The skin overlying the implant was closed normally. Maximum follow-up was three yr. In all cases, primary closure was achieved. One child received a second intra-abdominal transplant as an emergency, which later failed. The other kidneys are functioning well. One recipient developed a small incisional hernia three yr post-transplant. Another developed a skin dehiscence over the implant 23 days post-operatively. The implant was removed and skin closed. The other two recipients recovered well. Porcine dermal collagen implant is a helpful adjunct to abdominal wall closure following organ transplantation in children with donor size discrepancy.