Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI > 50)

Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Greece May 2005 Wilbur B. Bowne MD, Kell Julliard MS, Armando E. Castro MD, Palak Shah MD, Craig B. Morgenthal MD, Emad Kandil MD, Abel Gonzalez MD, Anthony J. Acinapura MD, George S. Ferzli MD, FACS

Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Disclosure of Interest Declaration None Greece May 2005

Background: 1 Hedley AA. JAMA 2002; 2847-2850. 2 Mason, EE. Gastroent Clin of North Am 1987;16:495-502. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ,[object Object],[object Object],[object Object],[object Object]

Background: 1 Ren, CJ. J. Gastrointest Surg 2004; 396-340. 2 Fielding, GA, Ren, CJ Surg Endosc 2003;17:1541-1545. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Background: Incidence of complications and failure following LAGB YEAR # PATIENTS AUTHOR Suter et al. 2001 272 20 7 Biertho et al. 2003 805 74 9 Suter et al. 2000 150 24 16 Chevallier et al. 2004 378 91 24 Hol é czy et al. 2001 36 11 31 Gustavson et al. 2002 90 52 58 # FAILURES % Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

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[object Object],[object Object],[object Object],Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese Methods:

[object Object],[object Object],[object Object],1 Belachew M. Surg Endosc 1994;8:1354-1356. 2 Shapiro K. Surg Endosc 2004;18:48-50. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

Background: 1 Bowne, W. J Am Coll Surg (submitted) 2005. 2 Feng, JJ. Surg Endosc 2003;17:1055-1060. 3 Himpens, J. Sem Laparosc Surg 2004;11:171-177. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Morbid Obesity N = 315 patients Super-Morbid Obesity N = 106 Patients (34%) LAGB N = 60 Patients (57%) LRYGB N = 46 Patients (43%) Results: Surgical Pathway Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

[object Object],[object Object],LRYGB (N=46) P-value 1 Characteristic Age 43 (21-65) 42 (18-63) 0.45 Gender (female/male) 35/11 50/10 0.35 BMI (Kg/ m 2 ) 57 (50-70) 55 (50-68) 0.18 Weight (Kg) 157 (120-195) 150 (124-209) 0.07 Excess weight (Kg) 92 (62 -124) 86 (66 -130) 0.08 1 Independent t-test LAGB (N=60) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

[object Object],[object Object],LRYGB (N=46) P-value 1 Co-morbidity Hypertension 26 (57%) 24 (40%) 0.07 Diabetes mellitus II 8 (18%) 11 (18%) 0.55 Respiratory (asthma) 15 (33%) 17 (28%) 0.75 Sleep Apnea 25 (54%) 28 (47%) 0.27 Degenerative arthritis 21 (46 %) 14 (23%) 0.13 Dyslipidemia 17 (37%) 17 (18%) 0.03 1 Pearson LAGB (N=60) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2

[object Object],[object Object],Operation time (min) 75 ± 22 (50-180) 121 ± 45 (70-210) < 0.001 Hospital stay (days) 1.8 ± 1.9 (1-11) 3.5 ± 3.4 (1-18) < 0.002 Conversion to open 1 0 LAGB (N=60) LRYGB (N=46) P 1 1 Independent t-test Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

[object Object],Results: LAGB median = 17 months LRYGB median = 13 months Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

[object Object],[object Object],N (%) P= 0.33 1 LAGB (N=60) Emesis/Dehydration 7 (12) Emesis/Dehydration 4 (9) Food impaction 1 (2) Pneumonia 1 (2) *Port displacement 1 (2) Anastomotic bleed 1 (2) Wound infection 1 (2) * Anastomotic leak 1 (2) Myocardial infarction 1 (2) * Abscess 1 (2) 1 Pearson LRYGB (N=46) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2 N (%) *Reoperation

[object Object],[object Object],N (%) (%) P < 0.05 1 LAGB (N=55) Emesis/Dehydration 24 (44) Emesis/Dehydration 5 (13) *Port displacement 11 (20) *Bowel Obstruction 3 (8) Food impaction 1 (2) Anastomotic stenosis 2 (5) Reflux 1 (2) Gastritis 1 (2) *Bland slippage 1 (2) *Abscess 1 (2) Wound infection 1 (2) † Aspiration Pneumonia 1 (2) 1 Pearson LRYGB (N=39) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2 *Reoperation † Postoperative death

Results: LAGB N= 15 (83%) LRYGB N=3 (17%) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese * P < 0.04 N = 18 * Pearson  2 ,[object Object]

Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ( N = 60) (N = 46) ,[object Object],1 Independent t-test

Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese N = 55 ,[object Object]

[object Object],Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese N = 106 1 Independent t-test

[object Object],Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 60) (N = 46) * P < 0.05 * Pearson  2

[object Object],Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 55) (N = 39) * * P < 0.05 * * Pearson  2

Patient satisfaction Results: Quality of Life Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 55) (N = 39)

[object Object],[object Object],[object Object],[object Object],Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI > 50)

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