Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients.

OBJECTIVE To evaluate the use of a low-pressure gastric band in the treatment of severe obesity in a prospective study. SUMMARY BACKGROUND DATA Gastric banding for severe obesity has been associated with erosion and perforation of the stomach. The Swedish adjustable gastric band (SAGB) has been proposed as a low-pressure device. METHODS From January 1998 to October 2001, 625 patients underwent laparoscopic SAGB. Median age was 36 years, and 80.4% of patients were female. Median preoperative body mass index (BMI) was 40. Previous upper abdominal surgery was reported in 36 (6%) patients. A five-trocar technique was used without a calibration balloon. RESULTS Median follow-up was 19.5 months. All patients were treated laparoscopically with a median operating time of 80 minutes. Conversion was necessary in two patients (0.3%): one trocar injury of the mesentery and one esophageal perforation. Median hospital stay was 3 days; there were no 30-day deaths. Early morbidity was present in 27 patients (4.3%). Late band reoperation was necessary in 49 patients (7.8%). Indications for reoperation were band slippage or pouch dilation, acute total dysphagia, and band leakage or malfunction. Median excess weight loss was 45.8%, 49.9%, and 47.4% after 1, 2, and 3 years, respectively, with a measurable beneficial effect on arterial hypertension, sleep apnea syndrome, and diabetes control. CONCLUSIONS SAGB is a safe and effective new method in the management of severe obesity. Long-term follow-up (>3 years) is necessary to confirm its effectiveness and safety.