Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Greec...
Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Discl...
Background: 1  Hedley AA.  JAMA  2002; 2847-2850. 2  Mason, EE.  Gastroent Clin of North Am  1987;16:495-502. Laparoscopic...
Background: 1  Hedley AA.  JAMA  2002; 2847-2850. 2  Mason, EE.  Gastroent Clin of North Am  1987;16:495-502. Laparoscopic...
Background: 1  Ren, CJ.  J. Gastrointest Surg  2004; 396-340. 2  Fielding, GA, Ren, CJ  Surg Endosc  2003;17:1541-1545. La...
Background: Incidence of complications and failure following LAGB   YEAR # PATIENTS AUTHOR Suter et al. 2001 272 20 7 Bier...
<ul><li>Background: </li></ul><ul><ul><li>Lack of outcome data comparing to laparoscopic  </li></ul></ul><ul><ul><li>Roux-...
<ul><li>Purpose: </li></ul><ul><ul><li>To determine and compare weight loss, change in BMI, incidence of complications, an...
<ul><ul><li>Retrospective review </li></ul></ul><ul><ul><li>Super-morbidly obese patients  </li></ul></ul><ul><ul><li>(BMI...
<ul><li>Methods:  </li></ul><ul><li>Laparoscopic adjustable gastric band </li></ul><ul><ul><li>Operative conduct (Pars fla...
Background: 1  Bowne, W.  J Am Coll Surg (submitted)  2005. 2  Feng, JJ.  Surg Endosc  2003;17:1055-1060. 3  Himpens, J.  ...
Morbid Obesity N = 315 patients Super-Morbid Obesity N = 106 Patients (34%) LAGB N = 60  Patients  (57%) LRYGB N = 46 Pati...
<ul><li>Results: </li></ul><ul><ul><li>Preoperative characteristics of patients   </li></ul></ul>LRYGB (N=46) P-value  1  ...
<ul><li>Results: </li></ul><ul><ul><li>Preoperative co-morbidity of patients  </li></ul></ul>LRYGB (N=46) P-value  1  Co-m...
<ul><li>Results: </li></ul><ul><ul><li>Perioperative data  </li></ul></ul>Operation time (min) 75  ± 22  (50-180) 121  ± 4...
<ul><ul><li>Adequate follow-up available for 106 patients identified </li></ul></ul>Results: LAGB median = 17 months LRYGB...
<ul><li>Results: </li></ul><ul><ul><li>Early complications ( < 30 days) </li></ul></ul>N (%) P= 0.33  1  LAGB (N=60) Emesi...
<ul><li>Results: </li></ul><ul><ul><li>Late complications ( ≥ 30 days) </li></ul></ul>N (%) (%)  P < 0.05  1  LAGB (N=55) ...
Results: LAGB N= 15 (83%) LRYGB N=3 (17%) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese * P < 0.04 N = 18 ...
Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ( N = 60)   (N = 46)   <ul><ul><li>Change in BMI </...
Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese N = 55 <ul><ul><li>Number of band adjustments </li>...
<ul><ul><li>Percent excess weight loss </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obe...
<ul><ul><li>Preoperative co-morbidity </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obes...
<ul><ul><li>Postoperative co-morbidity at last follow-up </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in S...
Patient satisfaction Results: Quality of Life Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 55) (N = ...
<ul><li>Summary: </li></ul><ul><ul><li>LAGB is associated with shorter operative time and hospital stay </li></ul></ul><ul...
<ul><li>Conclusion: </li></ul><ul><ul><li>LRYGB is associated with greater weight loss, reduction of co-morbidity, less co...
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Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI > 50)

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Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI > 50)

  1. 1. Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Greece May 2005 Wilbur B. Bowne MD, Kell Julliard MS, Armando E. Castro MD, Palak Shah MD, Craig B. Morgenthal MD, Emad Kandil MD, Abel Gonzalez MD, Anthony J. Acinapura MD, George S. Ferzli MD, FACS
  2. 2. Laparoscopic Adjustable Gastric Band in Super Morbidly Obese Patients (BMI >50): A Prospective, Comparative Analysis Disclosure of Interest Declaration None Greece May 2005
  3. 3. Background: 1 Hedley AA. JAMA 2002; 2847-2850. 2 Mason, EE. Gastroent Clin of North Am 1987;16:495-502. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese <ul><ul><li>Super- morbid obesity </li></ul></ul><ul><ul><ul><li>increasing prevalence in United States 1 </li></ul></ul></ul><ul><ul><ul><li>body mass index (BMI ≥ 50 kg/m 2 ) 1,2 </li></ul></ul></ul><ul><ul><ul><li>≥ 225 % ideal body weight 1,2 </li></ul></ul></ul>
  4. 4. Background: 1 Hedley AA. JAMA 2002; 2847-2850. 2 Mason, EE. Gastroent Clin of North Am 1987;16:495-502. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese <ul><ul><li>Surgeon’s perspective </li></ul></ul><ul><ul><ul><li>substantial co-morbidity 1,2 </li></ul></ul></ul><ul><ul><ul><li>technically challenging 1,2 </li></ul></ul></ul><ul><ul><ul><li>associated with worse outcome 1,2 </li></ul></ul></ul>
  5. 5. Background: 1 Ren, CJ. J. Gastrointest Surg 2004; 396-340. 2 Fielding, GA, Ren, CJ Surg Endosc 2003;17:1541-1545. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese <ul><ul><li>Laparoscopic adjustable gastric band (LAGB) </li></ul></ul><ul><ul><ul><li>most common in Europe and </li></ul></ul></ul><ul><ul><ul><li>Australia (1993) 1,2 </li></ul></ul></ul><ul><ul><ul><li>approved by FDA in 2001 1,2 </li></ul></ul></ul><ul><ul><ul><li>alternative treatment </li></ul></ul></ul><ul><ul><ul><li>strategy </li></ul></ul></ul>
  6. 6. Background: Incidence of complications and failure following LAGB YEAR # PATIENTS AUTHOR Suter et al. 2001 272 20 7 Biertho et al. 2003 805 74 9 Suter et al. 2000 150 24 16 Chevallier et al. 2004 378 91 24 Hol é czy et al. 2001 36 11 31 Gustavson et al. 2002 90 52 58 # FAILURES % Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  7. 7. <ul><li>Background: </li></ul><ul><ul><li>Lack of outcome data comparing to laparoscopic </li></ul></ul><ul><ul><li>Roux- en-Y gastric bypass (LRYGB) </li></ul></ul><ul><ul><li>Role of LAGB in super-morbidly obese patients </li></ul></ul><ul><ul><li>not well defined </li></ul></ul><ul><ul><li>Clarification of safety, feasiblity, and effectiveness </li></ul></ul><ul><ul><li>of LAGB </li></ul></ul>Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  8. 8. <ul><li>Purpose: </li></ul><ul><ul><li>To determine and compare weight loss, change in BMI, incidence of complications, and patient satisfaction after LAGB and LRYGB </li></ul></ul><ul><ul><li>To establish the effectiveness of LAGB and LRYGB on concomitant medical co-morbidity </li></ul></ul>Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  9. 9. <ul><ul><li>Retrospective review </li></ul></ul><ul><ul><li>Super-morbidly obese patients </li></ul></ul><ul><ul><li>(BMI ≥ 50 mg/kg 2 ) treated between </li></ul></ul><ul><ul><li>2001 and 2004 </li></ul></ul><ul><ul><li>Outcomes analysis </li></ul></ul><ul><ul><ul><li>Patient (Age, gender, BMI and weight loss) </li></ul></ul></ul><ul><ul><ul><li>Perioperative (Complications and reoperations) </li></ul></ul></ul><ul><ul><ul><li>Co-morbidity (Hypertension, diabetes, dyslipidemia, respiratory, and degenerative arthritis) </li></ul></ul></ul>Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese Methods:
  10. 10. <ul><li>Methods: </li></ul><ul><li>Laparoscopic adjustable gastric band </li></ul><ul><ul><li>Operative conduct (Pars flaccida technique) 1,2 </li></ul></ul>1 Belachew M. Surg Endosc 1994;8:1354-1356. 2 Shapiro K. Surg Endosc 2004;18:48-50. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  11. 11. Background: 1 Bowne, W. J Am Coll Surg (submitted) 2005. 2 Feng, JJ. Surg Endosc 2003;17:1055-1060. 3 Himpens, J. Sem Laparosc Surg 2004;11:171-177. Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese <ul><ul><li>Laparoscopic </li></ul></ul><ul><ul><li>Roux-en-Y gastric bypass: </li></ul></ul><ul><ul><ul><li>creation of a 30-cc gastric pouch 1 </li></ul></ul></ul><ul><ul><ul><li>extended Roux limb (150 cm) 1,2 </li></ul></ul></ul><ul><ul><ul><li>intracorporeal-sutured </li></ul></ul></ul><ul><ul><ul><li>gastrojejunostomy 1-3 </li></ul></ul></ul>
  12. 12. Morbid Obesity N = 315 patients Super-Morbid Obesity N = 106 Patients (34%) LAGB N = 60 Patients (57%) LRYGB N = 46 Patients (43%) Results: Surgical Pathway Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  13. 13. <ul><li>Results: </li></ul><ul><ul><li>Preoperative characteristics of patients </li></ul></ul>LRYGB (N=46) P-value 1 Characteristic Age 43 (21-65) 42 (18-63) 0.45 Gender (female/male) 35/11 50/10 0.35 BMI (Kg/ m 2 ) 57 (50-70) 55 (50-68) 0.18 Weight (Kg) 157 (120-195) 150 (124-209) 0.07 Excess weight (Kg) 92 (62 -124) 86 (66 -130) 0.08 1 Independent t-test LAGB (N=60) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  14. 14. <ul><li>Results: </li></ul><ul><ul><li>Preoperative co-morbidity of patients </li></ul></ul>LRYGB (N=46) P-value 1 Co-morbidity Hypertension 26 (57%) 24 (40%) 0.07 Diabetes mellitus II 8 (18%) 11 (18%) 0.55 Respiratory (asthma) 15 (33%) 17 (28%) 0.75 Sleep Apnea 25 (54%) 28 (47%) 0.27 Degenerative arthritis 21 (46 %) 14 (23%) 0.13 Dyslipidemia 17 (37%) 17 (18%) 0.03 1 Pearson LAGB (N=60) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2
  15. 15. <ul><li>Results: </li></ul><ul><ul><li>Perioperative data </li></ul></ul>Operation time (min) 75 ± 22 (50-180) 121 ± 45 (70-210) < 0.001 Hospital stay (days) 1.8 ± 1.9 (1-11) 3.5 ± 3.4 (1-18) < 0.002 Conversion to open 1 0 LAGB (N=60) LRYGB (N=46) P 1 1 Independent t-test Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  16. 16. <ul><ul><li>Adequate follow-up available for 106 patients identified </li></ul></ul>Results: LAGB median = 17 months LRYGB median = 13 months Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  17. 17. <ul><li>Results: </li></ul><ul><ul><li>Early complications ( < 30 days) </li></ul></ul>N (%) P= 0.33 1 LAGB (N=60) Emesis/Dehydration 7 (12) Emesis/Dehydration 4 (9) Food impaction 1 (2) Pneumonia 1 (2) *Port displacement 1 (2) Anastomotic bleed 1 (2) Wound infection 1 (2) * Anastomotic leak 1 (2) Myocardial infarction 1 (2) * Abscess 1 (2) 1 Pearson LRYGB (N=46) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2 N (%) *Reoperation
  18. 18. <ul><li>Results: </li></ul><ul><ul><li>Late complications ( ≥ 30 days) </li></ul></ul>N (%) (%) P < 0.05 1 LAGB (N=55) Emesis/Dehydration 24 (44) Emesis/Dehydration 5 (13) *Port displacement 11 (20) *Bowel Obstruction 3 (8) Food impaction 1 (2) Anastomotic stenosis 2 (5) Reflux 1 (2) Gastritis 1 (2) *Bland slippage 1 (2) *Abscess 1 (2) Wound infection 1 (2) † Aspiration Pneumonia 1 (2) 1 Pearson LRYGB (N=39) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese  2 *Reoperation † Postoperative death
  19. 19. Results: LAGB N= 15 (83%) LRYGB N=3 (17%) Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese * P < 0.04 N = 18 * Pearson  2 <ul><ul><li>Reoperations </li></ul></ul>
  20. 20. Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese ( N = 60) (N = 46) <ul><ul><li>Change in BMI </li></ul></ul>1 Independent t-test
  21. 21. Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese N = 55 <ul><ul><li>Number of band adjustments </li></ul></ul>
  22. 22. <ul><ul><li>Percent excess weight loss </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese N = 106 1 Independent t-test
  23. 23. <ul><ul><li>Preoperative co-morbidity </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 60) (N = 46) * P < 0.05 * Pearson  2
  24. 24. <ul><ul><li>Postoperative co-morbidity at last follow-up </li></ul></ul>Results: Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 55) (N = 39) * * P < 0.05 * * Pearson  2
  25. 25. Patient satisfaction Results: Quality of Life Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese (N = 55) (N = 39)
  26. 26. <ul><li>Summary: </li></ul><ul><ul><li>LAGB is associated with shorter operative time and hospital stay </li></ul></ul><ul><ul><li>LAGB patients experience greater incidence of late complicatons resulting in more reoperations </li></ul></ul><ul><ul><li>LAGB patients have less weight loss and reduction of comorbidities </li></ul></ul>Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese
  27. 27. <ul><li>Conclusion: </li></ul><ul><ul><li>LRYGB is associated with greater weight loss, reduction of co-morbidity, less complications, and fewer reoperations compared to LAGB </li></ul></ul><ul><ul><li>Quality of life of LRYGB patients is significantly better compared to LAGB patients </li></ul></ul><ul><ul><li>Further evaluation of LAGB in super-morbidly obese patient population appears warranted </li></ul></ul>Laparoscopic Adjustable Gastric Band in Super- Morbidly Obese

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