Obesity: Weiner R

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a 1. lékarská fakulta Univerzity Karlovy, Praha, Cesko. · Vnitr Lek. · Pubmed #18630623 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K, Anonymous00354. · Clinical Center for Minimally Invasive and Bariatric Surgery, Prague, Czech Republic. · Obes Surg. · Pubmed #17476884 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic. · Int J Obes (Lond). · Pubmed #17325689 No free full text.

Abstract: In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias JA, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R, Neugebauer EA, Anonymous00027. · European Association for Endoscopic Surgery, Post Office Box 335, Veldhoven, AH, 5500, The Netherlands. · Surg Endosc. · Pubmed #15580436 No free full text.

Abstract: BACKGROUND: The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. METHODS: A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. RECOMMENDATIONS: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

Stroh C, Hohmann U, Will U, Flade-Kuthe R, Herbig B, Höhne S, Köhler H, Pick P, Horbach T, Weiner R, Wolff S, Lippert H, Wolf AM, Schmidt U, Meyer F, Manger T, Anonymous00020. · Department of General, Abdominal and Pediatric Surgery, Municipal Hospital Teaching Hospital of the Friedrich-Schiller University at Jena, Germany, Strasse des Friedens 122, 07548, Gera, Germany. · Int J Colorectal Dis. · Pubmed #18535832 No free full text.

Abstract: BACKGROUND: Adjustable silicone gastric banding (ASGB) is an effective treatment in morbid obesity. Band migration is a long-term complication. Causes, clinical symptoms, timing and incidence are investigated in single centres only. In Germany, since January 1st, 2005, practice in bariatric surgery has been investigated in German prospective multicenter trial for quality assurance in obesity surgery. MATERIALS AND METHODS: All patients underwent ASGB in two centres of bariatric surgery in Germany were prospectively registered using a computer-based data form. Patients with band migration were retrospectively evaluated, in particular, causes and characteristics of its management. The results were correlated with data obtained from the German prospective multicentre trial. RESULTS: In total, 493 patients were enrolled in the study from February 1995 to February 2007. The follow-up rate was 79.9% (mean follow-up time period, 78.7 months; range, 2-148 months). Fifteen patients (3.0%) developed migration. In 14 cases, migration occurred within the range of 30-86 months after implantation. In one case, migration occurred 10 months after repositioning of the band. In the German multicentre trial, 629 patients underwent surgery during 2005 and 827 patients in 2006. In both periods, 74.4% of the patients were female and 25.6% male. The most frequently performed operation was ASGB (46.8%) followed by Roux-en-Y gastric bypass (38.5%). CONCLUSION: Band migration requires band removal. Different symptoms and complications influence the kind of band removal. Multicentre data were evident in the case of high long-term complication rate after ASGB. Data of the German multicentre trial show the trend from restrictive bariatric procedures to malabsorptive approach.

Weiner R, Bockhorn H, Rosenthal R, Wagner D. · Department of Surgery, Krankenhaus Nordwest, Frankfurt, Germany. · Surg Endosc. · Pubmed #11178766 No free full text.

Abstract: BACKGROUND: Slippage of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity. Retrogastric placement (RGP) of the band through the lesser sac can cause posterior slippage Incomplete suturing often is responsible for anterior slippage. A randomized prospective study was constructed to determine whether laparoscopic esophagogastric placement (EGP) is associated with a lower incidence of postoperative slippage and pouch dilation than RGP. METHODS: Morbid obese patients presenting for LASGB were randomized to undergo either an EGP (n = 50) or an RGP (n = 51). Patients were blinded to which procedure they underwent, and follow-up date were obtained by a blinded independent investigator. Standardized clinical and radiologic controls were used to assess pouch enlargement and slippage. RESULTS: Operating time was similar for the two procedures (54.5 min for EGP vs 58 min for RGP). There was no significant difference in postoperative weight loss (34 kg after EGP vs 37 kg after RGP within 12 months), esophagus dilation, or postoperative quality of life. There were two postoperative slippages and one pouch dilation in the RGP group and no postoperative complication in the EGP group. CONCLUSIONS: The placement of a LAP-BAND adjustable gastric banding system by the EGP technique is safe and results in a lower frequency of postoperative complications than its placement by the RGP technique. Clear anatomic landmarks are a benefit to education and to the learning curve for LASGB.

Weiner R, Wagner D, Blanco-Engert R, Bockhorn H. · Chirurgische Klinik, Krankenhauses Nordwest Frankfurt/Main. · Chirurg. · Pubmed #11077586 No free full text.

Abstract: BACKGROUND: Slippage (SP) of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LAS-GB) for morbid obesity. METHODS AND PATIENTS: A randomized prospective study was constructed in order to determine whether laparoscopic placement behind the cardia (RKP) is associated with a lower incidence of postoperative SP and pouch dilation than after a retrogastric placement (RGP) of the LAP band using a common technique. Morbidly obese patients presenting for LASGB were randomized to undergo either an RKP (n = 50) or an RGP (n = 51). RESULTS: There were three postoperative SP and three pouch dilations in the RGP group versus no postoperative complication in the RKP group. CONCLUSIONS: The placement of LAP band by the RKP technique is safe and followed by a lower frequency of postoperative complications than with the RGP technique. Clear anatomical landmarks are a benefit to the education and learning curve of LASGB.

Stroh C, Birk D, Flade-Kuthe R, Frenken M, Herbig B, Höhne S, Köhler H, Lange V, Ludwig K, Matkowitz R, Meyer G, Pick P, Horbach T, Krause S, Schäfer L, Schlensak M, Shang E, Sonnenberg T, Susewind M, Voigt H, Weiner R, Wolff S, Wolf AM, Schmidt U, Meyer F, Lippert H, Manger T, Anonymous00082. · Department of General, Abdominal, and Pediatric Surgery, Municipal Hospital, Strasse des Friedens 122, 07548, Gera, Germany, · Obes Surg. · Pubmed #19415404 No free full text.

Abstract: BACKGROUND: Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany). METHODS: Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI). RESULTS: Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m(2) received low-molecular-weight heparin twice a day. CONCLUSION: In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a Univerzita Karlova--1.lékarská fakulta, Praha, Ceská republika. · Rozhl Chir. · Pubmed #19174948 No free full text.

This publication has no abstract.

Stroh C, Birk D, Flade-Kuthe R, Frenken M, Herbig B, Höhne S, Köhler H, Lange V, Ludwig K, Matkowitz R, Meyer G, Meyer F, Pick P, Horbach T, Krause S, Schäfer L, Schlensak M, Shang E, Sonnenberg T, Susewind M, Voigt H, Weiner R, Wolff S, Lippert H, Wolf AM, Schmidt U, Manger T, Anonymous00033. · Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Gera, Germany. · Obes Surg. · Pubmed #18941846 No free full text.

Abstract: BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany). METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated. RESULTS: During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

Shang E, Hasenberg T, Magdeburg R, Keese M, Post S, Weiner R. · Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany. · Obes Surg. · Pubmed #18758872 No free full text.

Abstract: BACKGROUND: The only effective treatment for patients with morbid obesity is surgery. Laparoscopic bariatric surgery has become quite popular in attempts to decrease the morbidity associated with laparotomy. The aim of this study was to assess the safety and efficiency by using SurgASSIST(R) for performing the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (RYGBP). The variables were compared with the results using the standard laparoscopic circular end-to-end anastomotic stapler (CEEA(R)). METHODS: After randomization, the gastro-jejuostomy of RYGBP was performed in ten patients by transabdominal introduced circular stapler (group A) and in ten patients by transorally introduced circular stapler (SurgASSIST(R); group B) via five-port laparoscopy. A prospective 12-month postoperative follow-up including documentation of minor and major complication as well as weight loss and body composition is done every 8 weeks. RESULTS: The average body mass index (BMI, 52 kg/m(2)) and the other baseline characteristics were equally distributed in both groups. There was no difference in reduction of BMI, excess weight loss, and fat mass in both groups. The rate of port site wound infection in group A was significantly higher (p = 0.03) when compared to group B. There was no anastomotic leak or stricture postoperatively in both groups. CONCLUSIONS: Performing of a gastrojejunostomy in RYGBP by SurgASSIST is a safe and feasible method in comparison to conventional circular stapler systems. The advantage of SurgASSIST is the avoidance to introduce the stapler through the abdominal wall and, by this, a possible port site wound infection. Further prospective studies have to be performed to verify the advantages of the SurgASSIST in comparison to conventional circular stapler systems.

Weiner S, Karcz W, Rosenthal A, Pomhoff I, Weiner R. · Krankenhaus Sachsenhausen, Frankfurt. · MMW Fortschr Med. · Pubmed #16736684 No free full text.

Abstract: Obesity is a chronic condition associated with a reduction in the quality of life and a high risk for disease and death and requiring long-term care. In Germany, 51.4% of the population is overweight, with 9 million suffering from obesity and its consequences, such as hypertension, diabetes and sleep apnea. In addition, the number of patients undergoing treatment for painful chronic-degenerative disease of the joints is on the increase. After first exhausting all conservative therapeutic options, effective surgical measures can bring about a lasting overweight reduction of up to 50%. By this means, both pain and adverse consequences of obesity can be improved.

Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I. · Krankhenhaus Sachsenhausen, Frankfurt Center for Minimally Invasive Surgery, Section of Bariatric Surgery, Germany. · Obes Surg. · Pubmed #12841906 No free full text.

Abstract: BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated. METHODS: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 +/- 23.9 SD kg and body mass index (BMI) was 46.8 +/- 7.2 kg/m(2). Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida to perigastric (two-step technique) was used in the following 407 patients. RESULTS: Mortality and conversion rates were 0. Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1 gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m(2). 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded" LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100 patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). CONCLUSIONS: LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved. On the basis of 8 years long-term follow-up, it is an effective procedure.

Blanco Engert R, Gascon M, Weiner R, Rosenthal R, Brasesco O, Wagner D, Martin Esteban M, Bockhorn H. · Departamento de Cirugía General, Hospital Nordwest Fráncfort del Meno, Alemania. · Gastroenterol Hepatol. · Pubmed #11674956 No free full text.

Abstract: INTRODUCTION: Morbid obesity is the most frequent nutritional disorder in developed countries. Bariatric surgery is one option for the definitive treatment of this disorder. We present 407 patients who underwent implantation of adjustable silicone gastric banding. Ninety-four percent of the patients were satisfied with the procedure and its results. MATERIAL AND METHOD: We performed a retrospective study in the Surgery Department of the Nordwestkrankenhaus teaching hospital of the University of Frankfurt. From April 1996 to January 2000 we performed laparoscopic placement of adjustable silicone gastric banding in 407 patients, using Kuzmak's technique. Mean body mass index was 49.1 and mean weight was 139.2 kg. We describe the patient selection method and provide a detailed description of the technique and its possible problems. RESULTS: There was no operative or postoperative mortality. None of the patients required conventional surgery. Mean operating time was 62 minutes (including operating times during the learning period). Mean hospital stay was 5 days. We performed 24 (5,89%) reinterventions: 11 for displacement, 2 for erosion, 4 for infection of the reservoir, 2 due to review of the reservoir to prevent penetration and 4 due to dilatations of the pouch (changing the banding from a retrogastric to a retroesophageal position); one patient requested removal of the banding. Follow-up was performed at months 1, 6, 9 and 12. Mean weight loss was 28 kg at 6 months and 54 kg at 1 year. Mean weight loss in patients followed-up for 2 years was 58 kg. A total of 94.9% of the patients were satisfied with the procedure. CONCLUSIONS: Laparoscopic implantation of adjustable gastric banding (Lap-Band) combines the aims of conventional gastroplasty with the advantages of laparoscopic surgery in terms of postoperative morbidity and minimal invasiveness.

Weiner R, Datz M, Wagner D, Bockhorn H. · Chirurgische Klinik Krankenhaus Nordwest, Frankfurt a.M., Germany. · Obes Surg. · Pubmed #10638479 No free full text.

Abstract: BACKGROUND: The definition of success and failure of a bariatric procedure should include weight loss as well as improvement of comorbidity and quality-of-life (QoL) assessment. QoL measures changes in physical, functional, mental, and social health in order to evaluate benefits of new programs and interventions. MATERIAL AND METHODS: From April 1995 until March 1999, 287 patients underwent laparoscopic adjustable silicone gastric banding (LASGB) at Northwest Hospital Frankfurt a.M. (Germany). In this study, 100 of 287 patients (preoperative mean BMI 48.3 kg/m2; mean age 35.2 years) with a follow-up >18 month were evaluated. All patients underwent anonymous questionnaire (26 questions with a maximum score of 60) about different aspects of QoL outcome after LSAGB. RESULTS: In this study, 4 of 100 patients refused to give an answer to the QoL questions. Therefore 96 patients were evaluated. The QoL auto-evaluation of the patients shows that QoL generally improved after surgery in 92%. Using the scoring system, 44% of patients have excellent, 52% good, and only 4% bad results. The 4 patients who refused had to be classified as failure. General acceptance of LSAGB is wide, but gastrointestinal side effects are recognizable in more than 78% of operated patients. Successful weight loss is followed by an improvement of comorbidities. CONCLUSIONS: Safe, effective bariatric procedures increase the quality of life in morbidly obese patients markedly. Bariatric surgeons are committed to support and help their patients until they reach a new quality of life after obesity surgery.

Weiner R, Gutberlet H, Bockhorn H. · Chirurgische Klinik, Krankenhaus Nordwest, Frankfurt, Germany. · Obes Surg. · Pubmed #10484312 No free full text.

Abstract: BACKGROUND: In super, super obese patients (body mass index [BMI] >60), especially those with extreme intra-abdominal fat deposition, the technical difficulties in laparoscopic procedures increase. The purpose of this study was to evaluate whether gastric balloon therapy (GBT) can improve the operative conditions for laparoscopic adjustable gastric banding (LAGB) in extremely obese patients. MATERIALS AND METHODS: From April 1995 to August 1998, 196 LAGBs were performed. In 15 patients (7 female and 8 male), median age 38.8 years (range 17-54), who had been selected as suitable candidates for bariatric surgery, preoperative GBT was studied. Fourteen patients were extremely obese (BMI 60.2 kg/m2 [range 58-72]). One 17-year-old boy with BMI 46.6 kg/m2 was also treated. The Bioenterics Intragastric Balloon (BIB) was used. The placement, the volume modification, and the removal of the BIB were performed endoscopically. Close follow-up was possible in 14 patients. After balloon removal, 13 patients underwent LAGB. RESULTS: In 14 of 15 cases, GBT was successful. There was only one ballon dysfunction. The mean weight loss was 18.1 kg, and the median duration of balloon therapy was 16.8 weeks. After balloon removal, body weight started to increase. CONCLUSIONS: In our experience, the gastric balloon can improve the conditions for laparoscopic surgery in super and in super, super obese patients. There was no conversion to open surgery. The effect of weight loss is much less than immediately after LAGB. However, after failure of all conservative treatments to reduce the preoperative body weight, the GBT seems to be the last possibility.

Weiner R, Wagner D, Bockhorn H. · Chirurgische Klinik, Frankfurt am Main, Germany. · J Laparoendosc Adv Surg Tech A. · Pubmed #10194689 No free full text.

Abstract: Morbid obesity is a serious disease that is responsible for several comorbid conditions. Body mass indices > 40 require surgical procedures if diet programs fail. Laparoscopic adjustable gastric banding (LAGB), a more recently introduced gastric restrictive procedure, was designed to be a minimally invasive and reversible operation. 184 patients (164 women, 20 men) with a mean body mass index of 47.8 kg/m2 (range 36-79) were operated on. All patients had been excessively overweight for > 5 years. Each patient was given general anesthesia, and an adjustable LAP-BAND was implanted laparoscopically. The pouch size was 15 ml in all cases; and 3-4 sutures were placed to prevent dislocation. The conversion rate was 0%. The median operating time was 65 min (range 45-190). The mortality was 0%. The mean hospital stay was 5 days (range 4-6). The mean excess weight loss was 16% in 4 weeks, 23% in 3 months, 31% in 6 months, 58% in 1 year, and 87% in 2 years. The patient satisfaction index was 97.6%. Once a surgeon has acquired the necessary laparoscopic surgical experience, LAGB is a feasible, safe, and simple procedure with excellent postoperative results. LAGB does not permanently modify the anatomy of the stomach and maintains the natural continuity of the alimentary tract, while at the same time ensuring a steady weight reduction in morbidly obese patients. The fact that the gastric band can be applied laparoscopically is a significant advantage in this group of high-risk patients, who have less pain, faster postoperative recovery, more rapid return to normal activities, fewer wound infections, fewer hernia problems, and better cosmetic results. The rate of postoperative complications is approximately 9%. In 1.1% of patients, erosion occurred, and in 2.2%, slippage of the band. The rate of port-related complications was 3.2%. Reoperations were necessary in 6.4% of the patients.