Laparoscopic adjustable gastric banding: A prospective 4-year follow-up study

Background: A body mass index of greater than or equal to 40 kg/m(2) repres ents clinically severe obesity and warrants operative treatment if requeste d. The adjustable silicone gastric band and the Swedish adjustable gastric band are recently produced laparoscopic gastric restrictive devices. The ai m of this study was to assess all complications linked to both the availabl e gastric bands in a long-term follow-up. Methods: In a prospective study, the effects, complications, and outcomes o f this procedure were analyzed. The complications found were divided into e arly and general complications, and complications correlated to the bands. The technique of laparoscopic adjustable gastric banding is described. Foll ow-up was performed by the operating team. Results: Between July 1994 and August 1998, the authors operated on 158 pat ients and performed 102 adjustable silicone gastric bandings and 54 Swedish adjustable gastric bandings. The mean age at surgery was 36 years (range 1 7-72). The mean preoperative weight was 136 kg (89-230). Of 158 patients wh o underwent laparoscopic procedures, 156 (98%) could be followed up (mean 2 8 months; duration of follow-up, 6 weeks to 46 months). In early postoperat ive complications that required operation, one trocar wound hematoma (0.6%) and one wound infection of the port site (0.6%) were observed. The late co mplications that required reoperation were two pouch dilatations (1.3%), th ree band leakages (2%), one band migration (0.6%), and one late infection o f the port (0.6%). A debanding operation was necessary in one patient becau se of esophageal dysmotility disorder. No early or late postoperative morta lity was registered. The overall reoperation rate is currently about 7%. Conclusion: The operation is safe and effective. Moreover, adjustable gastr ic banding is fully reversible and is adjustable to the patient's needs. Th is study verifies the importance of correct operating technique. The author s' study and experience clearly indicate that laparoscopic adjustable gastr ic banding is an attractive alternative in the surgical treatment of morbid obesity.