Complications Associated with Laparoscopic Adjustable Gastric Banding for
Complications Associated with Laparoscopic Adjustable Gastric Banding for Morbid Obesity Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami Dr. Mahmoud Karami. Rad 2012, May 9 th
Definition of Obesity • BMI ≥ 30 • Excess weight more than 20% of Ideal Body Weight
Epidemiology of Obesity Worldwide WHO report 2010 35% of the world population Iran WHO report 2011 Overweight 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 Balloon� Gastric 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/m 2
Demographic Data Mean Age 32. 8 0. 7 years Mean Initial BMI 37 0. 3 kg/m 2 Mean BMI after surgery 29. 4 0. 3 kg/m 2 Mean Operation Time 20. 1 2. 3 minutes Mean Hospital Stay 17. 8 0. 8 hours Mean Time to Return to Work 6. 1 0. 4 days Mean Follow-up Period 16. 9 0. 9 months Median of % of weight loss (%WL) 20. 5 % Median Excess Body Weight Loss (EBWL) 32 %, Mean Weight Reduction 21. 4 0. 9 kg.
Outcome of Comorbidities Number of Comorbidities Complete Relative No change Remission 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
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
Complications Frequency (%) 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%) Pouch Enlargement 0 Band Removal 12%
Comparison of the complications between the patients with BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 BMI < 40 kg/m 2 BMI ≥ 40 kg/m 2 No Complications 84 (72. 4) 35 (77. 8) Slippage 18 (15. 5) 3 (6. 7) Port-site infection 8 (6. 9) 3 (6. 7) Erosion 3 (2. 6) 3 (6. 7) 1 0 (n=119) Phrenic Nerve Irritation (n=45) P Value 0. 7
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”
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