Background: Swedish adjustable gastric banding (SAGB) is currently one of the most performed laparoscopic procedures in bariatric surgery. This procedure was combined with an additional distal gastric bypass in patients with a BMI >50. Aim: To determine long-term outcome after SAGB and distal gastric bypass in a group of 37 consecutive patients studied prospectively. PATIENTS AND
Methods: Thirty seven patients, 11 men and 26 women, have been operated from 1996 to 2002. Age was 37±1 (mean±sem) years, BMI 54±1kg/m2. Follow-up was 65% at 60 months.
Results: Procedures: Most underwent a laparotomy (21) due to additional necessary surgery. Median hospital stay was 10 (4-26) days. One Patient died in hospital due to a pulmonary embolism, two patients needed antibiotic treatment for cystitis and pneumonia. 4 Patients suffered from local complications, such as wound infection, seroma, or healing problems. In one Patient the spleen was injured so splenectomie had to be performed in the same operation. Two patients required reoperation while still in hospital. Late complications were usually caused by problems with the SABG. Leakage of the adjustable ring in one patient, damage of the flexible tube in 6 patients. Mean time to occurance was 17.25 months (10 to 29). Three patients needed a second operation due to infections. In one patient a seroma needed to be removed 14 days after bariatric surgery. The same patient suffered from cholangitis due to choledocholithiasis 35 months later. In two patients the gastric banding was definitively removed after 95 months, there was significant dilatation of the oesophagus. Three patients required closure of hernias. Total cumulative reoperation rate was 62,9%. After 5 years BMI decreased from 54±1kg/m2 to 33±1kg/m2. Excess weight loss, EWL was 69±1% after 5 (n=24) and 70±1% after 7 (n=20) years. According to the Baros score the over all results are good. 5±3 points after 5 and 7 years. SUMMARY: 5 Years after SAGB with additional gastric bypass 71% of the patients reached > 65% EWL, 29% between 65 and 30% EWL. Weight reduction was a maintained between 5 to 7 years (EWL 71%). According to the Baros score the intervention was good, despite of a cumulative reoperation rate of 62,9%.
Conclusion: A majority of the patients does well even after 7 years. Due to the high reoperation rate, the combined operation of SAGB with additional distal gastric bypass should be considered as a rescue when non-combined procedures have failed.