BACKGROUND: Slippage of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage Incomplete suturing often is responsible for anterior slippage. A randomized prospective study was constructed to determine whether laparoscopic esophagogastric placement (EGP) is associated with a lower incidence of postoperative slippage and pouch dilation than RGP. METHODS:Morbid obese patients presenting for LASGB were randomized to undergo either an EGP (n = 50) or an RGP (n = 51). Patients were blinded to which procedure they underwent, and follow-up date were obtained by a blinded independent investigator. Standardized clinical and radiologic controls were used to assess pouch enlargement and slippage. RESULTS:Operating time was similar for the two procedures (54.5 min for EGP vs 58 min for RGP). There was no significant difference in postoperative weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagus dilation, or postoperative quality of life. There were two postoperative slippages and one pouch dilation in the RGP group and no postoperative complication in the EGP group. CONCLUSIONS: The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower frequency of postoperative complications than its placement by the RGP technique. Clear anatomic landmarks are a benefit to education and to the learning curve for LASGB.
RCT Entities:
BACKGROUND: Slippage of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage Incomplete suturing often is responsible for anterior slippage. A randomized prospective study was constructed to determine whether laparoscopic esophagogastric placement (EGP) is associated with a lower incidence of postoperative slippage and pouch dilation than RGP. METHODS: Morbid obesepatients presenting for LASGB were randomized to undergo either an EGP (n = 50) or an RGP (n = 51). Patients were blinded to which procedure they underwent, and follow-up date were obtained by a blinded independent investigator. Standardized clinical and radiologic controls were used to assess pouch enlargement and slippage. RESULTS: Operating time was similar for the two procedures (54.5 min for EGP vs 58 min for RGP). There was no significant difference in postoperative weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagus dilation, or postoperative quality of life. There were two postoperative slippages and one pouch dilation in the RGP group and no postoperative complication in the EGP group. CONCLUSIONS: The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower frequency of postoperative complications than its placement by the RGP technique. Clear anatomic landmarks are a benefit to education and to the learning curve for LASGB.
Authors: F Favretti; G B Cadiere; G Segato; J Himpens; L Busetto; F De Marchi; M Vertruyen; G Enzi; M De Luca; M Lise Journal: Obes Surg Date: 1997-08 Impact factor: 4.129
Authors: Pasquale Tammaro; Boris Hansel; Andrea Police; Marina Kousouri; Christophe Magnan; Jean Pierre Marmuse; Konstantinos Arapis Journal: World J Surg Date: 2017-08 Impact factor: 3.352
Authors: S Sauerland; L Angrisani; M Belachew; J M Chevallier; F Favretti; N Finer; A Fingerhut; M Garcia Caballero; J A Guisado Macias; R Mittermair; M Morino; S Msika; F Rubino; R Tacchino; R Weiner; E A M Neugebauer Journal: Surg Endosc Date: 2004-12-02 Impact factor: 4.584
Authors: Ruben Schouten; Dorothee C Wiryasaputra; Francois M H van Dielen; Wim G van Gemert; Jan Willem M Greve Journal: Obes Surg Date: 2010-12 Impact factor: 4.129