Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up

Laparoscopic adjustable silicone gastric banding (LASGB) has replaced vertical banded gastroplasty (VBG) as the most widespread restrictive bariatric operation in Europe. Although these two procedures are similar in principle, the experience concerning the preoperative examinations and follow-up cannot be arbitrarily transferred from VBG to LASGB. The reasons for and consequences drawn from radiologic and endoscopic examinations are described.

From December 1996 to January 2000, 148 patients (84% women, average age 39 years, body weight 127 kg, BMI 45 kg/m2) underwent LASGB. The mean follow-up was 17 months. Upper GI series, abdominal ultrasound, and gastroscopy were done before operation. The postoperative stoma adjustments were performed under radiological observation. All adjustments were analyzed.

Preoperative: Of 147 upper GI series, 74 showed hiatal hernia, 2 motility disorders, and 1 an incomplete malrotation. In 104 gastroscopies, 35 reflux and 53 gastritis with 24 Helicobacter pylori infections were found. Postoperative: On average, 2.7 radiological adjustments were done per patient. Until satisfactory satiety and weight reduction, 78% of the patients needed 0-3 adjustments. Besides routine adjustments, an additional 57 upper GI series were done in 35 patients, 44 times with opening of the stoma-diameter. A total of 14 slippages and 4 pouch enlargements were found. A gastroscopy was required in 12 patients.

Radiologic and endoscopic examinations before LASGB revealed pathology needing therapy in 42% of the patients and provided important additional information influencing the operative procedure. At an average follow-up of 17 months, 24% of the 148 patients needed unplanned additional upper GI series.