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Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

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Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2dure involves the placement of an adjustable silicone band around the very upper part of the stomach immediately below the gastroesophageal junction.

The level of restriction can be adjusted by adding or removing saline from the band via a subcutaneous port fixed to the anterior rectus sheath.LAGB i Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

s the safest of the bariatric procedures 11.21 with minimal mortality and morbidity. Il can be performed as an overnight slay or same-day procedure in

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

even the largest of patients.The mechanism of action of the LAGS is the induction of early satiation (food satisfaction) with a small meal followed b

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2there is a lack of correlation between over-restriction and satiety 13]. Similarly, the band should not physically limit significantly food transit an

d there should be negligible food found above the band after a meal if the band is correctly adjusted |4|. A range of hormones including insulin, lept Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

in, ghrelin. pancreatic polypeptide. and peptide YY do not play a significant role in LAGB function (5.6|. It is hypothesized that the mechanical effe

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

cts of the band and the passage of food bolus through this area of band resistance can generate myoenteric pressure signals 17Ị. Signals from these re

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2se receptors remain poorly understood |8|.Ongoing improvements in band placement and postoperative management have reduced morbidity as well as shortt

erm and long-term complications. There have been a number of changes to the procedure of LAGB placement and aftercare since the original description. Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

The surgical technique has been modified, and the majority of LAGB are now placed by the pars flaccida approach rather than the perigastric approach [

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

9]. A randomized controlled trial comparing these techniques demonstrated fewer long-term complicationswith the pars flaccida approach than the periga

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2rograms. An optimal program will provide regular follow-up focusing on educating patients about correct food choices, small serving sizes, and emphasi

zing the importance of eating slow ly and chewing the food well. Band adjustments should focus on the induction of early and prolonged satiety and whe Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

n this is achieved, weight loss is optimal. Hunger and food seeking behavior suggests that the band is under-filled. Symptoms of reflux and an inabili

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

ty to eat solid food suggest the band is over-adjusted and that fluid should be removed ị31.Outcomes of LAGB surgery can be measured by change in weig

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2ust be considered in the context of the safely of the revision as well as the effect of the revision on weight, health, and well-being.Weight Loss Out

comesWeight loss after gastric banding is typically very steady at 0.5-1 kg/week. This means that weight loss progresses over a 2- to 3-year period an Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

d then Stabilizes, usually in the range of 40-55 % EWL. Medium- and long-term (4- to 15-year follow-up) outcomes have been reported by individual seri

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

es showing a great variation in weight loss results from 33 to 70 % EWL 111. 121 (Tables I and 2).Tire weight loss following LAGB is gradual. 0.5-1 kg

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2s 114. 15). After the fust year, most patients only require six monthly or annual visits. This model of care tits with the management of obesity as a

chronic disease, and has been shown to he cost-effective II6-18J.S.A. Biethauer el al. (eds.). Minimally Invasive Bariatric Surgery.DOI IO.IOO7/978-l- Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

4939-l637-5_2O. © Springer Science*Business Media New York 2015193194J. Ponce and W.A. BrownThere have been two prospective multicenter Food and Drug

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

Administration-monitored clinical trials in the United States. The Lap Band trial A 119] recruited patients from 1995 lo 1998 in eight centers: 259 ou

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 28 % al 24 nxHilhs. and 36.2 % al .36 months. The very high incidence of gastric prolapse ami slippages was attributed to lire learning curve, as most

of the surgeons involved were inexpe ricnccd laparoscopic surgeons, as well as the use of the perigas-ưic dissection rather than pars flaccida. There Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

was also a lack of effective follow up. with an average of only 1.2 adjustments in the first year. Ihc majority of patients were adjusted by radiologi

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

st based on a contrast swallow evaluation rather than tailoring the adjustment to the patient's sensation of satiety. There was no grxxl band-specific

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2ally by pars ilaccida technique. Ibis trial included centers with both large and no experience with gastric banding management. The mean % EWL at 3 ye

ars was 41.1 %.Tvnir I. Gastric handing short- and medium-term weight loss (1-8 years)■ IA.I.•!.:study1 year 2 years3 years4 years 5 years « yearsIDA Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

triabLap-Bn nd A" It 9)36(1995-2001)Swedish Band 12<)|41(2003-2006)Riuuit imiỉed slutliesAngrisani Ct al. |21|47Nguyen el at. [22]45OBrien el at.1- [2

Ebook Minimally invasive bariatric surgery (2nd edition): Part 2

3]87Dixon Ct al? 125162O'Brien et al. [24]73Dixon Ct al. |26|•toSyMmaiic "Views

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

20Laparoscopic Adjustable Gastric Banding: OutcomesJaime Ponce and Wendy A. BrownIntroductionThe laparoscopic adjustable gastric banding (LAGB) proced

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