Laparoscopic adjustable gastric banding:a report of 228 cases

Objective:To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding(LAGB)in obese patients.Methods:This retrospective study included 228 patients(73 males and 155 females,mean age,32.5±10.3 years)who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011.The body weight and postoperative complications were followed up.Results:The pre-operative mean body mass index(BMI)was 39.5±6.3 kg/m^(2).Except in one case of inadequate exposure of the stomach,all laparoscopic procedures were successfully accomplished,with no conversion to open surgery.The mean operation time was 65.0±20.3 min.The mean hospital stay was 2.7±0.9 days.Early postoperative complications(<30 days)occurred in five cases(2.2%)and late complications(>30 days)occurred in 75 cases(32.9%),including 56 cases(24.6%)with band-associated complications.The percentage of excess weight loss(EWL%)at 1,3 and 5 years was 40.5±30.5%,59.5±41.5%and 58.9±46.4%,respectively.The percentages of patients with EWL%>25%,>50%and>75%were,respectively,60%,33%and 0%at 1 year follow-up,43%,39%,and 16%at 3 years follow-up and 40%,34%and 16%at 5 years follow-up.Conclusion Although LAGB has low peri-operative mortality and morbidity rates,it is associated with a high late complication rate and unsatisfactory weight loss.It may be optional,but not the first choice,for the treatment of obesity.

Achalasia after bariatric Roux-en-Y gastric bypass surgery reversal

Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. To our knowledge, there are only three reported cases of achalasia after Roux-en-Y gastric bypass and no reported cases after revision of the surgery. We present a case of a 70-year-old female who had a previous history of Roux-en-Y gastric bypass with revision. She presented with persistent nausea and regurgitation for one month. Esophagogastroduodenoscopy showed a dilated esophagus without strictures or stenosis. A barium study was performed after the endoscopy and was suggestive of achalasia. Those findings were confirmed by a manometry. The patient was referred for laparoscopic Heller's myotomy.

Endoscopic management of intragastric penetrated adjustable gastric band for morbid obesity

This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.

Laparoscopic revolution in bariatric surgery

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

Involvement of midgastric transverse band in gastric empting delay of functional dyspepsia

Background Midgastric transverse band （MTB） was first observed over 100 years ago, after that many researchers worked on the subject postulated its physiologic role and the role in gastrointestinal diseases, but its function remains unclear. With progress of imaging methods, the nature of MTB is unveiling. In this study we investigated the effect of MTB on the gastric empting delay in functional dyspepsia （FD） and explored the mechanism. Methods A total of 60 patients with FD and 65 age- and sex-matched healthy people who served as controls were studied. With ^99mTc-DTPA labeled semi-solid fat-parched flour served as test meal, gastric empting was examined in all subjects by using single photon emission computed tomography. Test meal was designated as general （60 g fat-parched flour） or large （80 g fat-parched flour） meal. Stomach was divided into proximal and distal parts by MTB. Half gastric empting time, areas of different gastric parts, intragastric food distribution and MTB width were tested with in given times. Results Patients with FD showed a delayed gastric empting and increased intragastric residue. Global and regional gastric erupting velocity was decreased. The areas of distal stomach and MTB were significantly greater in the FD patients than in the controls. Throughout the whole test period a distal stomach-dominated food distribution was shown. Those who took a large meal had longer half gastric empting time and greater MTB area than those who took a general meal. Conclusions Gastric empting delay is related to enlarged MTB area. Some dyspeptic symptoms may be induced by abnormal distribution and increased retention of food in distal stomach. MTB, being like atriaventricular valve that controls blood flow in heart, regulates transport, distribution, and empting of food in the stomach.