The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus

• Published in: Obesity surgery Vol. 11; no. 1; pp. 76 - 86
• Main Authors: Peternac, D, Hauser, R, Weber, M, Schöb, O
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.02.2001
• Subjects: Analysis of Variance; Barium Sulfate; Body Mass Index; Body Weight; Bulimia - complications; Bulimia - physiopathology; Contrast Media; Dilatation, Pathologic - diagnostic imaging; Dilatation, Pathologic - etiology; Esophagus; Esophagus - diagnostic imaging; Esophagus - surgery; Female; Gastrointestinal surgery; Gastroplasty - adverse effects; Gastroplasty - methods; Gastroscopy - adverse effects; Gastroscopy - methods; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Obesity; Obesity, Morbid - complications; Obesity, Morbid - diagnosis; Obesity, Morbid - surgery; Radiography; Reoperation; Retrospective Studies; Silicones; Stomach - diagnostic imaging; Stomach - surgery; Surgical outcomes; Surgical techniques; Time Factors; Treatment Outcome; Weight control; Weight Loss
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1381/096089201321454150

Pouch development is a potentially serious problem following gastric banding, and reoperation is often demanded to maintain long-term function of the lap band. Laparoscopic gastric banding was performed with two different calibrations of the pouch. Within a period of 12 months, postoperative pouch behavior with regard to volume and shape was evaluated retrospectively, as were changes in the distal esophagus. The pouches of 14 patients with intraperitoneal band positioning were calibrated at 25 ml. The volumes of 54 patients operated by a suprabursal technique were set at 15 ml. We performed three radiological examinations and calculated the volumes using the ellipsoid formula d1 x d2 x d3 x pi/6. Four morphologically different pouch types have been observed: regular, concentric, eccentric-medial and eccentric-lateral. The phi-angle corresponds to the angle between the spinal column and the gastric band. In the first group, the pouch volume increased from 21.2 ml +/- 21.2 to 87.9 ml +/- 64.6 (p=0.006) and the BMI fell from 47.1 kg/m2 +/- 8.4 to 38.1 kg/m2 +/- 7.0 (p=0.001). The pouch volume of the second group increased from 10.4 ml +/- 5.8 to 38.8 ml +/- 29.1 (p<0.001), and the BMI reduced from 48.4 kg/m2 +/- 6.9 to 39.3 kg/m2 +/- 6.7 (p<0.001). If the phi-angle is smaller than 4 degrees, the pouch is of the eccentric-medial type. The transbursal operative technique is responsible for the development of the eccentric-medial pouch. If the anterior sero-muscular fixative sutures tear, an eccentric-lateral pouch results. All pouch types are affected by changes at the pouch-esophageal junction and by pathological developments in the distal and middle oesophagus.