[Are complications of gastric banding decreased with cuff fixation?]

The gastric bandage is reliable method for long time control of weight loss in failed conservative cure of morbid obese patients. Since 1983 we have been concerned with bariatric surgery at the First Surgical Department of General Faculty Hospital of Charles University. 691 morbid obese patients (BMI 49.7 kg/m2, mean age of 38.1) underwent gastric banding (GB)--by laparotomy 58 obese patients and since 1993 by laparoscopy 633 obese patients. After 12 months the mean weight loss was 21.1 kg (14-32 kg) and after 24 month the mean weight loss was 38.7 kg (27-73 kg). In period of 1993-1998 the most frequent late complication in the group of 517 obese patients after laparoscopic nonadjustable gastric banding (LNGB) was in 5.1% dilatation of upper gastric pouch or slippage of anterior stomach wall above the band with vomiting and failure of gastric evacuation. In majority we removed GB laparoscopically. To prevent this complication we modified GB with fixing band with a cuff made from the anterior gastric wall. To test the effectiveness of this method we implemented in 1998-1999 a prospective randomized study. In the group of 80 morbid obese patients we created in 40 patients (n1-GB+C) LNGB with the cuff fixation and in 40 patients (n2-GB-C) without fixation. We followed-up of this patients after LNGB was in 6 weeks, 6 months and 12 months with measurement of pouch volume by endoscopy with calibrate endocannula. One year after GB in the 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 pouch volume was 33.6 ml, i.e. 154.1% of the original size. The slippage or dilatation of the pouch was in group nl in one case while in group n2 in three cases (p < 0.001).