Postoperative management of Laparoscopic gastric banding

Background: The authors investigated the postoperative management of morbidly obese patients treated, by laparoscopic adjustable gastric banding (LAGB) with the Lap-Band(R) System. Methods: The 3-year postoperative band management is presented in 379 morbidly obese patients, divided according to intra-operative band filling and quartiles of maximum postoperative band filling. Results: LAGB resulted in a 40.8+/-24.5 percent excess weight loss (%EWL). Stoma stenosis occurred in 87 patients (23.0%), pouch dilatation in 52 (13.7%) and esophageal dilatation in 22 (5.8%). Most band-related complications were controlled by simple band deflation. The mean number of postoperative band adjustments was 2.3+/-1.7, and mean maximum band filling after surgery was 2.8+/-1.2 ml. Weight loss at 3 years was identical in 205 patients who had the band completely unfilled at surgery and in 174 patients who had the band filled with 1 to 3 ml of sterile saline. The rate of band-related complications was significantly lower in the first group. No differences in %EWL were observed between quartiles of maximum band filling after surgery. The rate of band-related complications increased with increasing levels of postoperative maximum band filling. In patients with the band filled with <3.0 ml of sterile saline at 6 months, the inflation of further saline produced a dose-related increase in the rate of weight loss. In patients with the band filled with ≥3.0 ml of sterile saline at 6 months, the inflation of further saline was associated with a reduced %EWL. Conclusion: Postoperative adjustability of the LapBand(R) was useful in the treatment of band-related complications and was able to significantly influence the rate of weight loss. On the other hand, aggressive postoperative band filling was associated with an increased rate of complications.