Is fixation during gastric banding necessary? A randomised clinical study

Area of Science:

• Bariatric Surgery
• Surgical Techniques
• Obesity Management

Background:

• Anterior fixation using gastro-gastric sutures is standard in laparoscopic adjustable gastric banding (LAGB) to prevent complications.
• The necessity and impact of this fixation technique on safety and efficacy remain unproven.
• Non-fixation could potentially reduce operative time and surgical adhesions, possibly simplifying revisional procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of a non-fixation technique for LAGB compared to standard gastro-gastric fixation.
• To assess postoperative complications, operative time, and weight loss over a 2-year follow-up period.

Main Methods:

• A 3-year randomized clinical trial was designed.
• 81 patients undergoing LAGB were randomized into two groups: gastro-gastric suture fixation (Group A, n=41) and no fixation (Group B, n=40).
• Outcomes included postoperative complications, operative time, and percentage of excess BMI loss (%EBMIL).

Main Results:

• No significant differences were found in 2-year %EBMIL (35.9% vs 39.4%) or mean BMI at 2 years.
• Operative time was shorter in the non-fixation group (72 min vs 82 min).
• Three early band slippages occurred in the non-fixation group, versus none in the fixation group, leading to study interruption.

Conclusions:

• While non-fixation of LAGB may reduce operative time, it carries a risk of early postoperative band slippage.
• The study suggests that gastro-gastric fixation remains a recommended practice to mitigate this risk.
• Further research may be needed to optimize LAGB techniques and patient outcomes.