Abstracts
1997 Digestive Disease Week

Prospective investigation of complications, reoperations and sustained weight loss with an adjustable gastric banding device for treatment of morbid obesity.

C Doherty, JW Maher, DS Heitshusen. Department of Surgery, University of Iowa School of Medicine, Iowa City, IA.

This investigative study reports on the complications, reoperations and sustained weight loss observed over a 5 year experience with an adjustable gastric banding device. Methods: The adjustable gastric band was placed at laparotomy around the proximal fundus and tightened to create an outlet channel of 12 millimeters using a pressure sensor. The upper gastric pouch was sized using a peroral 25 ml balloon on a calibration tube. The adjustable bladder of the band was connected by tubing to a small reservoir implanted in the rectus sheath. Results: Between March 17, 1992 and May 1, 1995, 26 females and 14 males entered the study. Mean age was 34 years, (range 19-51 years). Mean height 171 centimeters, (range 152-190 centimeters); mean weight 147 kilograms (range 100-214 kilograms); mean Body Mass Index 50 (range 39-75). There was no operative mortality. Weight loss observed during the followup periods were the following:

 Time        Preop     1 year      2 years    3 years    4 years
 Mean Wt.    147 kg.   113 kg. *   112 kg. *  119 *      121 kg. *
 Mean BMI    50.0      38.5        38.0       40.2       42.4
 Number      40        39          34         23         10
 Followup    100%      97.5%       100%       95.5%      90%
 *p < 0.001 by paired t-test compared to preop.

Thirty-two reoperations (12 intrabdominal procedures and 20 abdominal wall procedures) have been necessary to maintain efficacy or correct complications. Problems identified include: reservoir leakage 37.5%, posterior hemiation of the stomach through the band 30%, aneurysmal dilatation of the inflatable bladder 7.5%, enlarged pouch 10%, infected reservoir 5%, inaccessible reservoir malposition 7.5%. After fifty-seven months 28 subjects remain in the study. Twelve individuals have withdrawn from the study. Three did not want an ineffective ASGB removed operatively; two had an ASGB removed operatively; five had an ASGB removed and a vertical banded gastroplasty performed at the same operation, and two had an ASGB removed and a LapBand implanted at the same operation. Conclusion: Forty severely obese adults have had an adjustable silicone gastric band safely placed by laparotomy. Weight loss has been acceptable, but 32 reoperations have been necessary to maintain efficacy of the adjustable gastric band or correct problems associated with this implantable device.