A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity

Background: Slippage of the stomach is the most common postoperative compli cation after laparoscopic adjustable silicone gastric banding (LASGB) for m orbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage Incomplete suturing often is responsible f or anterior slippage. A randomized prospective study was constructed to det ermine whether laparoscopic esophagogastric placement (EGP) is associated w ith a lower incidence of postoperative slippage and pouch dilation than RGP . Methods: Morbid obese patients presenting for LASGB were randomized to unde rgo either an EGP (n = 50) or an RGP (n = 51). Patients were blinded to whi ch procedure they underwent, and follow-up date were obtained by a blinded independent investigator. Standardized clinical and radiologic controls wer e used to assess pouch enlargement and slippage. Results: Operating time was similar for the two procedures (54.5 min for EG P vs 58 min for RGP). There was no significant difference in postoperative weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagu s dilation, or postoperative quality of life. There were two postoperative slippages and one pouch dilation in the RGP group and no postoperative comp lication in the EGP group. Conclusions: The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower frequency of postoperat ive complications than its placement by the RGP technique. Clear anatomic l andmarks are a benefit to education and to the learning curve for LASGB.