Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®.

BACKGROUND: Gastric banding still represents one of the most widely used bariatric procedures. It provides acceptable weight loss in many patients, but has frequent long-term complications. Because different types of bands may lead to different results, we designed a randomized study to compare the Lapband® with the SAGB®. We hereby report on the long-term results. METHODS: Between December 1998 and June 2002, 180 morbidly obese patients were randomized between Lapband® or SAGB®. Weight loss, long-term morbidity, and need for reoperation were evaluated. RESULTS: Long-term weight loss did not differ between the two bands. Patients who maintained their band had an acceptable long-term weight loss of between 50 and 60 % EBMIL. In both groups, about half the patients developed long-term complications, with about 50 % requiring major redo surgery. There was no difference in the overall rates of long-term complications or failures between the two groups, but patients who had a Lapband® were significantly more prone to develop band slippage/pouch dilatation (13.3 versus 0 %, p < 0,001). CONCLUSIONS: Although in the absence of complication, gastric banding leads to acceptable weight loss; the long-term complication and major reoperation rates are very high independently from the type of band used or on the operative technique. Gastric banding leads to relatively poor overall long-term results and therefore should not be considered the procedure of choice for the treatment of morbid obesity. Patients should be informed of the limited overall weight loss and the very high complication rates

Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?

BACKGROUND: Roux-en-Y gastric bypass (RYGBP), one of the commonest performed bariatric procedures, remains a technically challenging operation associated with significant morbidity in high-risk patients. This study was conducted in order to identify predictors of complications after laparoscopic RYGBP. METHODS: Our prospectively established database has been assessed to review 30-day and in-hospital complications graded according to a validated scoring system (Clavien-Dindo) and separated into minor (Clavien-Dindo I-IIIa) and major (Clavien-Dindo IIIb-IV) complications. Patient- and procedure-related factors were analyzed using univariate analysis. Significant factors associated with morbidity were introduced into a multivariate analysis to identify independent predictors. RESULTS: Between 1999 and 2012, 1573 patients underwent laparoscopic RYGBP, 374 male and 1199 female. Mean age was 41 years, and mean body mass index (BMI) was 44.5 kg/m(2). One hundred fifty-nine procedures were reoperations. One hundred fifty (9.5 %) patients developed at least one complication, and 43 (2.7 %) had major complications, leading to death in one case (0.06 %). Risk factors for morbidity were male gender (p = 0.006) and overall experience of the team (p < 0.0001). Prolonged 3-day antibiotic therapy was associated with significantly reduced overall (p < 0.0001) and major (p = 0.005) complication rates. Major complications were associated with smoking (p = 0.016). CONCLUSIONS: The most significant individual risk factors for early complications after RYGBP are male gender, limited surgical experience, and single dose of antibiotics. RYGBP should be performed by experienced teams. Smoking should be discontinued before surgery. Prolonged antibiotic therapy could be considered, especially if a circular stapled gastrojejunostomy is performed with the anvil introduced transorally

Bypass gastrique en Y selon Roux pour obésité sévère – Résultats à long terme [Long-term results after Roux-en-Y gastric bypass for severe obesity]

Long-term results after Roux-en-Y gastric bypass for severe obesity Abstract. Roux-en-Y gastric bypass (RYGB) has been performed for almost 50 years, yet long-term results have only been scarcely reported. In this paper, we report results up to 15 years after gastric bypass and review the relevant literature on long-term results after this operation. Our prospective database has been reviewed for this study. A literature search via Pubmed was done, and articles reporting on 10-year results after RYGB in at least 50 patients were retrieved and analyzed. A total of 822 patients underwent primary RYGB in our institutions between 1999 and 2007. All are eligible for 10-year analysis, and 186 operated before 2003 for 15-year analysis. Follow-up rates after 10 and 15 years are 76 and 55 % respectively. Patients loose a mean of 12,9 BMI units after 10 years, a figure that remains unchanged after 15 years. 80 %, respectively 72 % of patients maintain a %total body weight loss of at least 20 % after 10 and 15 years. Comorbidities are markedly improved, as well as quality of life. These results compare well with those reported in the literature after this length of time. Studies from the literature also show a preventive effect of RYGB in the development of metabolic comorbidities in obese individuals submitted to RYGB. RYGB provides good to excellent long-term weight loss which persists up to 15 years after surgery. This is associated with markedly improved comorbidities and reduced cardiovascular risk, improved quality-of-life and reduced mortality. RYGB represents a good option for most patients who seek surgery for severe obesity

Laparoscopic Roux-en-Y gastric bypass for failed gastric banding: outcomes in 642 patients.

Laparoscopic adjustable gastric banding (LAGB) is a well-tolerated procedure but has high long-term complication and failure rates. Laparoscopic conversion to Roux-en-Y gastric bypass (LRYGB) is one of the rescue strategies. To analyze short- and long-term results of reoperative LRYGB after failed LAGB. Three European expert bariatric center (2 university hospitals and 1 regional hospital). A retrospective review of prospectively collected data, including all consecutive patients submitted to revisional LRYGB for failed LAGB between 1999 and 2013, was performed. Complications were classified according to the Dindo-Clavien system. Long-term results in terms of weight loss were analyzed in a subgroup of patients. A total of 642 patients (569 women and 73 men) were included. Mean±standard deviation operating time was 188±43 minutes. There was no mortality and an overall complication rate of 9.7%, including 3.6% major complications, with no difference between the 1- or 2-step approaches. Follow-up rate was 88% at 10 years for the Swiss patient cohort. The mean excess body mass index loss was between 65% and 70% throughout the study period, and the mean total weight loss was between 28% and 30% based on the maximum weight. The mean body mass index decreased from 44.7 kg/m(2) before LAGB to 31.6, 32.2, and 32.5 kg/m(2) at 1, 5, and 10 years after revision. Revisional LRYGB is well tolerated and feasible after failed LAGB. A 1-step approach, in cases without erosion, does not increase operative morbidity. Results up to 10 years after revision are comparable to those reported after primary LRYGB

Laparoscopic Roux-en-Y gastric bypass in patients over the age of 60 years

The prevalence of obesity is increasing even in older patients. Bariatric surgery is often considered more risky in this group, and not necessarily associated with the same benefits as in younger patients. In France, guidelines recommend to assess indication for surgery based on comorbidities and physiological age