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Seven Year Follow-Up After Swedish Laparoscopic Gastric Banding (Sagb)
Bruno M. Balsiger*1,2, Daniel Giachino3, Ruedi Bachmann3, Andreas Glaettli2
1Gastroenterology, University of Basel, Basel, Switzerland; 2Visceral surgery, Hirslanden Salem-Spital, Bern, Switzerland; 3Surgery, Tiefenauspital, Bern, Switzerland

Background: Swedish adjustable gastric banding (SAGB) is currently one of the most performed laparoscopic procedures in bariatric surgery. Only few data is available about long-term follow up. AIM: To determine long-term outcome after SAGB in a group of 190 consecutive patients studied prospectively. PATIENTS AND
Methods: Hundred ninety patients, 39 men and 151 women, have been operated from 1996 to 2005. Age was 39±1 (mean±sem) years. Mean follow-up was 96.5% at 63±2 months.
Results: Procedures: 187 were done laparoscopically, 4 needed conversions, and 3 had a primary celiotomy. Median hospital stay was 6 (2-35) days, 3 patients were in the ICU for 3 days and 9 for 1 day. One early bleeding required reoperation. 6 patients had pulmonary, cardiac or allergic complications. Late complications were band migration 1%, leakage 5% or slipping 6%. Pouch dilatation was seen in 16%. 45/190 (24%) required reoperations. 31 had a band replacement (9 band leakage, till 1999) 1 band removal, 13 received a Roux-en-Y-gastric bypass. Minor reoperations (tube replacement, port related and hernias) were needed in 13/190 (7%) of the patients. Total cumulative reoperation rate was 31%. One patient died after late complications after reoperation for a gastric bypass (0.5%). BMI decreased from 44±1kg/m2 to 34±1 kg/m2 (Excess weight loss, EWL 56±2%) after 4 (n=71) and to 33±1kg/m2 (EWL 60±4%) after 7 (n=48) years. According to the Baros score the over all results are good. 6.6±2 after 4 and 4.6±3 after 7 years. SUMMARY: 7 years after SAGB 51% of the patients reached >65% EWL, 27% between 65 and 35% EWL and 22% of the patients <35% EWL. Overall there was a maintained weight reduction between 4 to 7 years (EWL 60±4%). According to the Baros score the intervention was good, despite of a cummulative reoperation rate of 24-31%.
Conclusion: After 1999 less reoperations because of band leakage were needed because of material improvement. 51% of the patients do very well even after 7 years, whereas 22% have a poor outcome, leading to reoperation. We still need to find criteria to preoperatively distinguish the “band patient” from the “band intolerant or non-responsive patient” who needs a gastric bypass procedure in the first place.

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