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Adjustable Laparoscopic Gastric Banding in Patients with Morbid Obesity: Radiographic Management, Results, and Postoperative Complications¹

¹ From the Departments of Medical Radiology, Institute of Diagnostic Radiology (W.W., M.H.), and Surgery, Division of Visceral Surgery (O.S., R.S.H.), Zurich University Hospital, Switzerland. From the 1998 RSNA scientific assembly. Received August 7, 1998; revision requested September 25; final revision received November 29, 1999; accepted December 7. Address correspondence to W.W., Institute of Diagnostic Radiology, Basel University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland (e-mail: wwiesner@uhbs.ch).

PURPOSE: To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications.

MATERIALS AND METHODS: From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22–62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m²) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6–8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions.

RESULTS: Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection.

CONCLUSION: ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.

Index terms: Fluoroscopy • Laparoscopic surgery, 722.1269 • Obesity • Stomach, function, 722.91 • Stomach, surgery, 722.1269 • Surgery, complications, 72.458

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