Complications Associated with Laparoscopic Adjustable Gastric

Banding for Morbid Obesity

Dr. Mojtaba HashemzadehDr. Leila Zahedi-ShoolamiDr. Mahmoud KaramiRad

2012, May 9th

Definition of Obesity

•BMI ≥ 30 •Excess weight more than 20% of Ideal Body

Weight

Epidemiology of Obesity

Worldwide Iran

WHO report 201035% of the world population

WHO report 2011Overweight 51.4%Obese 19.4%

Case Selection

18.5 < BMI < 25 Normal

25 <BMI < 30 Overweight Diet, Exercise, Medical Treatment

30 < BMI < 35 Obesity Grade I Diet, Exercise, Balloon

35 <BMI < 40 Obesity Grade II Gastric Banding/Plication

40 < BMI < 45 Obesity Grade III Sleeve Gastrectomy

BMI > 45 Super Obese BalloonGastric Bypass

Gastric Banding Benefits

• Performed through Laparoscopy

• Short surgery duration• Short clinic stay• Being adjustable • Safe with low complication

rate• The most favorable

technique for obesity treatment in the United States

Methods & Patients

•Time: January 2005 - February 2012•Setting: A single private setting in Tehran, Iran

•Sample Size: 165 obese patients with BMI between 32 and 50 kg/m2

Demographic Data

Mean Age 32.80.7 years

Mean Initial BMI 370.3 kg/m2

Mean BMI after surgery 29.40.3 kg/m2

Mean Operation Time 20.12.3 minutes

Mean Hospital Stay 17.80.8 hours

Mean Time to Return to Work 6.10.4 days

Mean Follow-up Period 16.90.9 months

Median of % of weight loss (%WL) 20.5 %

Median Excess Body Weight Loss (EBWL) 32 %,

Mean Weight Reduction 21.40.9 kg.

Outcome of Comorbidities

Number of Comorbidities

Complete Remission

Relative Remission

No change

Getting Worse

Dyslipidemia 14 4 7 3 0

Diabetes 7 1 6 0 0

Hypertension 6 3 1 2 0

Sleep Apnea 4 2 1 1 0

Fatty Liver 3 3 0 0 0

Degenerative Joint Disease

2 1 0 1 0

Early Gastric Banding Complications

▫Bleeding ▫Perforation

Late Gastric Banding Complications• Port Infection

▫Prior to adjusting (< 1 month): Sterility problems

▫Post adjusting (> 1 month): Erosion Unsterile injection

• Slippage• Erosion• Opening of the gastric band clips• Pouch Enlargement• Acute obstruction due to band connection tube

ComplicationsFrequency (%) Literature Management

No Complications 126 (76.3) -

Early Port Infection 8 (4.8%) Conservative

Late Port Infection 3 (1.8%) 1.8% Band Removal

Anterior Prolapse 13 (7.8%) 1-22% Conservative

Slippage 8 (4.8%) 1-22% Band Repair

Erosion 6 (3.6%) 0-11% Band Removal

Phrenic Nerve Irritation

1 (0.6%) Band Removal

Pouch Enlargement 0 12%

Comparison of the complications between the patients with BMI < 40 kg/m2 and BMI ≥ 40 kg/m2

BMI < 40 kg/m2

(n=119)

BMI ≥ 40 kg/m2

(n=45)

P Value

No Complications 84 (72.4) 35 (77.8)

0.7

Slippage 18 (15.5) 3 (6.7)

Port-site infection 8 (6.9) 3 (6.7)

Erosion 3 (2.6) 3 (6.7)

Phrenic Nerve Irritation 1 0

Port Infection

Slippage

Prolapse

Erosion

Opening of the gastric band clips (X-Ray)

Opening of the gastric band clips

Replacing the Gastric Band

Before LAGB After LAGB

What to do in order to decrease the complication rate?

•Proper case-selection•Considering the sterility principles•Changing eating habits in patients•Avoiding vomiting

“Thank you for your attention”