Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience.

BACKGROUND: The duodenal switch (DS) is a variant of the biliopancreatic diversion (BPD) for surgical treatment of morbid obesity. Absence of dumping syndrome leads to a high quality of life in these patients. The complexity of the laparoscopic BPD-DS is high, and the technical aspects of the duodeno-ileostomy are still under consideration. MATERIALS AND METHODS: Laparoscopic BPD-DS is described, with early surgical outcomes of 63 patients reported. We used 3 different techniques for creation of the duodeno-ileostomy, which were compared. RESULTS: 2 staple-line leaks at the gastric sleeve and 1 anastomotic leak after circular stapling of the duodeno-ileostomy occurred. In the same patient with the leak, a marginal ulcer was registered 4 months after surgery. There were no differences in the operating-time between the 3 groups. The combined linear stapled and totally hand-sewn anastomosis were the safest methods to perform the duodeno-ileostomy. Local wound infection at a trocar site (insertion of the circular stapler) was the most common local complication, occurring in 3 patients after using the circular stapling technique only. Postoperative stay was 4 to 8 days, except for the 3 patients with complications. CONCLUSION: Laparoscopic BPD-DS is an advanced, complex and feasible technique in bariatric surgery. The combined linear stapled and total hand-sewn anastomosis are not only the technically easiest procedures to perform, but also appear to be the safest techniques.

Outcome after laparoscopic adjustable gastric banding, using the Lap-Band and the Heliogast band: a prospective randomized study.

BACKGROUND: A study was performed to assess the usefulness and efficacy of a new type of band (Heliogast) for laparoscopic adjustable gastric banding (LAGB) for the treatment of morbid obesity, compared with the Lap-Band. METHOD: From January to May 2001, a prospective randomized study of 60 LAGB procedures was conducted: group I (n=30), the Lap-Band system (INAMED); group II (n=30), the Heliogast band (Hélioscopie). We implanted the devices using the 2-step technique (pars flaccida to peri-gastric) by laparoscopy. Port systems were placed on the rectus sheath and were fixed by non-absorbable sutures. Follow-up of all patients was a minimum of 12 months. RESULTS: There were no differences in operating-time, intra-operative complications, or weight loss during the first 4 weeks after surgery. However, with increasing time, more complications with the Heliogast band and differences in weight loss favoring the Lap-Band became significant. CONCLUSION: Based on the results of this study, we recommend that new bands have independent clinical evaluation before commercialization.

Outcome after laparoscopic adjustable gastric banding - 8 years experience.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated. METHODS: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 +/- 23.9 SD kg and body mass index (BMI) was 46.8 +/- 7.2 kg/m(2). Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida to perigastric (two-step technique) was used in the following 407 patients. RESULTS: Mortality and conversion rates were 0. Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1 gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m(2). 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded" LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100 patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). CONCLUSIONS: LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved. On the basis of 8 years long-term follow-up, it is an effective procedure.

[Indications, technique and results of laparoscopic gastric bypass operation]. / Indikation, Technik und Ergebnisse nach laparoskopischer Magen-Bypass-Operation.

UNLABELLED: Laparoscopic Roux en-Y-Gastric Bypass (RYGB) has been performed in our initial series in 50 patients. METHODS: The results of surgery, technique, including 3-12 months follow-up, are described with 100% follow-up in the first 50 patients. Weight loss, operative morbidity and relief of co-morbidities have been thoroughly studied in a prospective way. RESULTS: Diabetes mellitus was normalized and gastroesophageal reflux was relieved in all patients. Length of stay, recovery time and cosmetic results are superior to the 'open' technique, and the operative times are comparable. CONCLUSION: Laparoscopic RYGB deserves a place in the operative repertoire of bariatric surgeon.

[Acute appendicitis--laparoscopic appendectomy--indications and outcomes]. / Akute Appendizitis--Laparoskopische Appendektomie--Indikation und Ergebnisse.

UNLABELLED: Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery. RESULTS: Laparoscopic Appendectomy (LA) is a safe procedure resulting in shorter hospitalization and sooner return to activity. The relative merits of LA and open appendectomy (OA) are evaluated in this review. There were no differences in postoperative analgesia, resumption of oral intake, or morbidity, but laparoscopic appendectomy is associated with longer operating times and increased cost. Laparoscopic appendectomy is a more expensive alternative but offers advantages related to pain relief, length of stay, return to normal activities, or morbidity. CONCLUSION: In those clinical settings where surgical expertise and equipment are available and affordable, diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA.

[Video-laparoscopic placement of adjustable gastric banding (lap-band) in the treatment of morbid obesity. Preliminary results after 407 interventions]. / Aplicación de la bandeleta gástrica ajustable (lap-band) por videolaparoscopia en el tratamiento de la obesidad mórbida. Resultados preliminares tras 407 intervenciones.

INTRODUCTION: Morbid obesity is the most frequent nutritional disorder in developed countries. Bariatric surgery is one option for the definitive treatment of this disorder. We present 407 patients who underwent implantation of adjustable silicone gastric banding. Ninety-four percent of the patients were satisfied with the procedure and its results. MATERIAL AND METHOD: We performed a retrospective study in the Surgery Department of the Nordwestkrankenhaus teaching hospital of the University of Frankfurt. From April 1996 to January 2000 we performed laparoscopic placement of adjustable silicone gastric banding in 407 patients, using Kuzmak's technique. Mean body mass index was 49.1 and mean weight was 139.2 kg. We describe the patient selection method and provide a detailed description of the technique and its possible problems. RESULTS: There was no operative or postoperative mortality. None of the patients required conventional surgery. Mean operating time was 62 minutes (including operating times during the learning period). Mean hospital stay was 5 days. We performed 24 (5,89%) reinterventions: 11 for displacement, 2 for erosion, 4 for infection of the reservoir, 2 due to review of the reservoir to prevent penetration and 4 due to dilatations of the pouch (changing the banding from a retrogastric to a retroesophageal position); one patient requested removal of the banding. Follow-up was performed at months 1, 6, 9 and 12. Mean weight loss was 28 kg at 6 months and 54 kg at 1 year. Mean weight loss in patients followed-up for 2 years was 58 kg. A total of 94.9% of the patients were satisfied with the procedure. CONCLUSIONS: Laparoscopic implantation of adjustable gastric banding (Lap-Band) combines the aims of conventional gastroplasty with the advantages of laparoscopic surgery in terms of postoperative morbidity and minimal invasiveness.

[A new technique for laparoscopic placement of the adjustable gastric band (LAP-band) for preventing slippage]. / Eine neue Technik zur laparoskopischen Plazierung des steuerbaren Magenbandes (LAP-Band) zur Vermeidung eines Slippage.

BACKGROUND: Slippage (SP) of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LAS-GB) for morbid obesity. METHODS AND PATIENTS: A randomized prospective study was constructed in order to determine whether laparoscopic placement behind the cardia (RKP) is associated with a lower incidence of postoperative SP and pouch dilation than after a retrogastric placement (RGP) of the LAP band using a common technique. Morbidly obese patients presenting for LASGB were randomized to undergo either an RKP (n = 50) or an RGP (n = 51). RESULTS: There were three postoperative SP and three pouch dilations in the RGP group versus no postoperative complication in the RKP group. CONCLUSIONS: The placement of LAP band by the RKP technique is safe and followed by a lower frequency of postoperative complications than with the RGP technique. Clear anatomical landmarks are a benefit to the education and learning curve of LASGB.