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52. Treatment of Morbid Obesity by Laparoscopic Adjustable Gastric Banding Needs a Team Approach Thomas Ricklin', Grazyna PieC2 , Rudolf Steffen2, Brigitta von Wegberg2, Fritz F. Horber2 'Clinic Hirslanden, Zurich, 2 OBEX-Institutes, Zurich and Bem Switzerland In Europe, laparoscopic implantation of Swedish adjustable gastric band (SAGB) is a frequently performed restrictive bariatric treatment for morbid obesity. However long term complication rates, efficiency of weight reduction with/or without additional antiobesity drugs and treatment strategies in patients with SAG13 related complications are vastly unknown. Therefore 498 (female/male; 3.7/1) consecutive patients were prospectively investigated following SAGB implantation. Patients characteristics: age: 47 ± 1 years, BMI: 43 ± 1 kg/M2, excessive body weight (EBW): 90 ± 1 %. Excessive weight loss (EWL) after surgery was: first year: 30.4 ± 0.4 % (n=420), second year: 43.5 ± 1.0 % (n=267), third year: 51.4 ± 3.0 % (n=45). System unrelated complications were: < 30 days: 3.6 %, > 30 days: 1.6 %. 6.0% system related complications were observed; band related complications (n=13; 2.6%: band intolerance (1.4%), band leak (0.6%), band slipping (0.2%), band penetration (0.2%) and esophagus perforation (0.2%); port/tube related complications (n=17; 3.4%: port-a-cath infection (0.6%), port-a-cath discomfort (1.2%), tube disconnection (1.0%) and tube leak (0.6%). As a consequence 12 (2.4 %) major reoperations (band related: laparoscopic (n=5; 1.0%) and open (n=7; 1.4%) and 19 (3.8 %) minor revisions (port/tube related) were performed. As a result, all but 1 patient had a functioning restrictive system. Insufficient Weight Loss (IWL) (n=71; 14.2%) was treated either surgically with an additional malabsorptive bypass (n=4; 0.8 %) or with additional antiobesity drugs (orlistat and/or sibutramine, n=50; 10.0%), leaving only 4 of the 54 patients with IWL. 17 (3.4%) patients with IWL were not treated to date. In summary, 36 reoperations were performed (32 due to system complications and 4 due to IWL in 27 patients (5.4%). Conventional additional bariatric operations were needed in 12 patients (2.4%). All complications occurred mostly during the first 2 years. Moreover, orlistat and sibutramine had a high impact in reducing frequency (92% of treated patients) of patients with IWL. In conclusion, implantation of an adjustable gastric band in morbid obese patients is save, has a complication rate below 7%, results in more than 50% EWL after 3 years, but still needs additional expertise in drug therapy and conventional bariatric procedures to be successful. Combining all 3 therapeutic modalities (SAG13, conventional bariatric procedure and drugs) result in a success rate of sufficient weight loss of more than 95% of all patients treated with SAG13. |
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