Adjustable gastric and esophagogastric banding - Is a pouch compulsory?

Background: Pouch volume and stoma diameter are believed to have a signific ant impact on the efficacy of restrictive bariatric surgery. However, it is not clear whether the pouch is compulsory in stoma-adjustable gastric and esophagogastric banding. Methods: Between April 1997 and April 1998, we performed 26 esophagogastric and 109 gastric bandings. using the Swedish Adjustable Gastric Band (SAGB) . The patients were assigned to four groups defined according to the initia l of the volume pouch (as determined radiologically): esophagogastric bandi ng (no pouch), gastric banding <7.5 ml, gastric banding 7.5-15 ml, and gast ric banding 15-30 ml. Weight loss, increase in pouch volume, symptoms, and complications were recorded 6 and 12 months postoperatively. Results: All but one patient achieved significant weight reduction; there w ere no significant differences among the study groups. Increase in pouch vo lume was observed in 0-31.8% of patients. Preexisting heartburn and regurgi tation improved postoperatively in all groups, but dysphagia developed in t he esophagogastric banding group postoperatively. Two band migrations occur red in the esophagogastric banding group, and two pouch dilatations were ob served in the gastric banding groups. Conclusions: Pouch volume is a negligible factor in terms of weight reducti on and complications following adjustable esophagogastric or gastric bandin g. Postoperative dysphagia represents a drawback of esophagogastric banding .