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[Fixation of a non-adjustable gastric band using an anterior gastric wall cuff (randomized study)]
M Kasalický1, M Fried, M Pesková
1I. chirurgická klinika VFN 1. LF UK, Praha.
Insights
Fixing adjustable gastric bands with a cuff may reduce slippage complications. This study compared gastric band (GB) with cuff fixation to standard GB in morbidly obese patients, finding reduced pouch enlargement over one year.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Laparoscopic gastric banding (GB) is a standard bariatric procedure for morbid obesity.
- A common complication is proximal pouch enlargement due to dilatation or slippage.
- This can lead to gastric evacuation disorders and vomiting.
Purpose of the Study:
- To evaluate the effectiveness of fixing non-adjustable gastric bands with an anterior gastric wall cuff.
- To reduce the incidence of proximal pouch enlargement and slippage after laparoscopic GB.
Main Methods:
- A prospective randomized study compared gastric band with cuff (GB + C) to standard gastric band (GB - C).
- Eighty morbidly obese patients were divided into two groups.
- Endoscopic assessment evaluated pouch volume changes after one year.
Main Results:
- The GB + C group showed a mean pouch volume increase of 124% (14.6 ml).
- The GB - C group showed a mean pouch volume increase of 154.1% (33.6 ml).
- The difference in pouch volume increase was statistically significant (p < 0.001).
Conclusions:
- Fixing non-adjustable gastric bands with an anterior gastric wall cuff appears to reduce proximal pouch enlargement.
- This modification may decrease the incidence of slippage complications after laparoscopic GB.
- Further research with larger cohorts is warranted to confirm these findings.
Abstract:
We have been concerned with bariatric surgery at the First Surgical Clinic of th General Faculty Hospital, First Medical Faculty, Charles University Prague since 1983. In 1983-1986 vertical gastroplasties were made, between 1986 and 1993 non-adjustable gastric bands were provided by the laparotomic approach. Since 1993 when we were the first to implement a gastric band operation (GB) by the laparoscopic route, this method is used as the standard method. In 1993-1998 we made at the First Surgical Clinic 517 laparoscopic GB operation on account of morbid obesity in patients with a body mass index of 34-49 kg/m2. The group comprised 449 women and 59 men. The most frequent late complication in our group of morbidly obese patients who had a laparoscopically administered GB was in 5.1% enlargement of the proximal pouch above the GB by dilatation of its wall or slippage of the anterior wall proximally under the GB with a subsequent disorder of gastric evacuation and vomiting. We tried to reduce the incidence of this complication by fixing the GB by a cuff made from the anterior gastric wall. To test the effectiveness of the suggested fixation of the non-adjustable GB by a cuff we implemented in 1998-1999 a prospective randomized study in a group of 80 morbidly obese patients divided into experimental group n1-GB + C with the cuff and a control group n2-GB - C without a cuff. We investigated the incidence of the mentioned complication and the changed volume of the pouch above the GB after one year. Endoscopic assessment of the size of the pouch above the GB after surgery and after one year revealed that in group n1-GB + C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB - C the mean increase of the volume was 33.6 ml, i.e. 154.1% of the original size (p < 0.001). Based on the assembled results and aware of the fact that small groups were involved, we should like to express the assumption that the suggested modification, i.e. fixation of a non-adjustable GB by a cuff made from the anterior gastric wall can reduce the incidence of the complication of slippage of the anterior gastric wall proximally above the bandage.