complications associated with laparoscopic adjustable gastric banding for morbid obesity
DESCRIPTION
Complications Associated with Laparoscopic Adjustable Gastric Banding for Morbid Obesity. Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami Dr. Mahmoud KaramiRad. 2012, May 9 th. Definition of Obesity. BMI ≥ 30 Excess weight more than 20% of Ideal Body Weight. Epidemiology of Obesity. - PowerPoint PPT PresentationTRANSCRIPT
Complications Associated with Laparoscopic Adjustable Gastric
Banding for Morbid Obesity
Dr. Mojtaba HashemzadehDr. Leila Zahedi-ShoolamiDr. Mahmoud KaramiRad
2012, May 9th
Definition of Obesity
•BMI ≥ 30 •Excess weight more than 20% of Ideal Body
Weight
Epidemiology of ObesityWorldwide Iran
WHO report 201035% of the world population
WHO report 2011Overweight 51.4%Obese 19.4%
Case Selection
18.5 < BMI < 25 Normal
25 <BMI < 30 Overweight Diet, Exercise, Medical Treatment
30 < BMI < 35 Obesity Grade I Diet, Exercise, Balloon
35 <BMI < 40 Obesity Grade II Gastric Banding/Plication
40 < BMI < 45 Obesity Grade III Sleeve Gastrectomy
BMI > 45 Super Obese BalloonGastric Bypass
Gastric Banding Benefits
• Performed through Laparoscopy
• Short surgery duration• Short clinic stay• Being adjustable • Safe with low complication
rate• The most favorable
technique for obesity treatment in the United States
Methods & Patients
•Time: January 2005 - February 2012•Setting: A single private setting in Tehran, Iran
•Sample Size: 165 obese patients with BMI between 32 and 50 kg/m2
Demographic Data
Mean Age 32.80.7 yearsMean Initial BMI 370.3 kg/m2 Mean BMI after surgery 29.40.3 kg/m2 Mean Operation Time 20.12.3 minutesMean Hospital Stay 17.80.8 hoursMean Time to Return to Work 6.10.4 daysMean Follow-up Period 16.90.9 monthsMedian of % of weight loss (%WL) 20.5 %Median Excess Body Weight Loss (EBWL) 32 %,Mean Weight Reduction 21.40.9 kg.
Outcome of ComorbiditiesNumber of Comorbidities
Complete Remission
Relative Remission
No change
Getting Worse
Dyslipidemia 14 4 7 3 0
Diabetes 7 1 6 0 0
Hypertension 6 3 1 2 0
Sleep Apnea 4 2 1 1 0
Fatty Liver 3 3 0 0 0Degenerative Joint Disease 2 1 0 1 0
Early Gastric Banding Complications
▫Bleeding ▫Perforation
Late Gastric Banding Complications• Port Infection
▫Prior to adjusting (< 1 month): Sterility problems
▫Post adjusting (> 1 month): Erosion Unsterile injection
• Slippage• Erosion• Opening of the gastric band clips• Pouch Enlargement• Acute obstruction due to band connection tube
ComplicationsFrequency (%) Literature Management
No Complications 126 (76.3) -
Early Port Infection 8 (4.8%) Conservative
Late Port Infection 3 (1.8%) 1.8% Band Removal
Anterior Prolapse 13 (7.8%) 1-22% Conservative
Slippage 8 (4.8%) 1-22% Band Repair
Erosion 6 (3.6%) 0-11% Band Removal
Phrenic Nerve Irritation
1 (0.6%) Band Removal
Pouch Enlargement 0 12%
Comparison of the complications between the patients with BMI < 40 kg/m2 and BMI ≥ 40 kg/m2
BMI < 40 kg/m2
(n=119)BMI ≥ 40 kg/m2
(n=45)P Value
No Complications 84 (72.4) 35 (77.8)
0.7
Slippage 18 (15.5) 3 (6.7)
Port-site infection 8 (6.9) 3 (6.7)
Erosion 3 (2.6) 3 (6.7)
Phrenic Nerve Irritation 1 0
Port Infection
Slippage
Prolapse
Erosion
Opening of the gastric band clips (X-Ray)
Opening of the gastric band clips
Replacing the Gastric Band
Before LAGB After LAGB
What to do in order to decrease the complication rate?
•Proper case-selection•Considering the sterility principles•Changing eating habits in patients•Avoiding vomiting
“Thank you for your attention”