Download PDF
Zentralbl Chir 2005; 130(5): 410-418
DOI: 10.1055/s-2005-836873
Originalarbeiten und Übersichten

© Georg Thieme Verlag Stuttgart · New York

Langzeitergebnisse nach Gastric Banding

Long-Term Results After Gastric BandingC. Stroh1 , U. Hohmann1 , H. Schramm1 , T. Manger1
  • 1Departement für Allgemein- und Viszeralchirurgie, SRH Wald-Klinikum Gera gGmbH, Akademisches Lehrkrankenhaus der Friedrich-Schiller-Universität Jena
Further Information

Publication History

Publication Date:
11 October 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Das Gastric Banding ist eine weit verbreitete bariatrische Operation in Europa. Die Häufigkeit von Langzeitkomplikationen wie Pouchdilatation, Slippage und Bandmigration und der Langzeiteffekt der Gewichtsreduktion sind in Metaanalysen und wenigen Langzeitbeobachtungen untersucht. Wir berichten über unsere Erfahrungen mit dem Gastric Banding. Methoden: In 10 Jahren wurde bei 168 Patienten eine Gastric Banding-Operation durchgeführt. Präoperative Daten, der postoperative Gewichtsverlust und Langzeitkomplikationen wurden prospektiv erfasst und retrospektiv analysiert. Ergebnisse: Das Durchschnittsalter der Patienten war 41,7 Jahre mit einem mittleren BMI von 49,6 kg/m². In den ersten 30 Tagen postoperativ traten keine Todesfälle auf. Die Konversionsrate betrug 7,1 %. 79,8 % der Patienten (n = 134) unterzogen sich einem regelmäßigem Follow-up (mittlere Nachbeobachtungszeit 66,7 Monate). Postoperative Langzeitkomplikationen traten bei 22,5 % der Patienten auf. 30 Komplikationen (17,8 %) waren Band-abhängige Komplikationen und 8 (4,7 %) waren Komplikationen von Seiten des Portsystems. Der mittlere Übergewichtsverlust betrug 39,6; 47,3; 44,2; 43,4 und 32 % nach 1, 2, 4, 5, und 8 Jahren. Fazit: Durch das Gastric Banding kann ein effektiver Gewichtsverlust erzielt werden. Jedoch beeinflussen Band-abhängige Komplikationen und funktionelle Aspekte die Langzeitergebnisse. Richtlinien zur Wahl der geeigneten bariatrischen Methode sind notwendig, um die Therapieversager und die Komplikationsrate zu reduzieren.

Abstract

Background: Adjustable gastric banding is a popular bariatric operation in Europe. The rate of long-term complications like pouch dilatation, slippage and band migration and the long-term effect of weight loss are reported in meta-analysis and few studies for a period of more than five years. We report on experiences after gastric banding. Methods: Over a period of 10 years 168 patients with morbid obesity were treated with gastric banding. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained and retrospectively analyzed. Results: Mean age of the patients was 41.7 years with a mean preoperative BMI of 49.6 kg/m². No intraoperative or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 7.1 %. 79.8 % of the patients (n = 134) were available for follow up (mean follow-up time 66.7 months). Long-term complications occurred in 22.5 % of the patients. 30 complications (17.8 %) were related to the band and 8 (4.7 %) to the access-port or to the tube. Mean excess weight loss was 39.6, 47.3, 44.2, 43.4 and 32 % after 1, 2, 4, 5 and 8 years. Conclusions: Laparoscopic gastric banding can achieve an effective weight loss. However band-related and functional complications will influence the late outcome. Pathways to choose the best surgical method for the individual patient are necessary to reduce failures after gastric banding.

Schlüsselwörter

morbide Adipositas - bariatrische Chirurgie - Gastric Banding - Slippage - Pouchdilatation - Bandmigration

Key words

morbid obesity - bariatric surgery - gastric banding - slippage - pouch dilatation - band migration

Literatur

  • 1 Ablassmaier B, Opitz I, Jacobi C A, Müller J M. Intragastrale Penetration eines justierbaren Magenbandes.  Chirurg. 2001;  72 838-843
    CrossrefPubMedGoogle Scholar
  • 2 Alvarez-Cordero R, Castillo-Gonzalez G, Ramfez-Wiella G, Aragon-Viruette E. Lessons learned after 2 years Lap-Band experience (Abstract).  Obes Surgery. 1998;  4 395
    PubMedGoogle Scholar
  • 3 Baca I, Götzen V, Amend G. Laparoskopisches „Gastric Banding” bei Adipositas permagna.  Zbl Chir. 1999;  124 451-460
    PubMedGoogle Scholar
  • 4 Belachew M, Legrand M, Vincent V, Defferereux T. et al . Laparoscopic placement of adjustable silicone gastric band in the treatment of morbid obesity: How to do it.  Obes Surg. 1995;  6 66-70
    PubMedGoogle Scholar
  • 5 Belachew M, Legrand M J, Vincent V. et al . Laparoscopic adjustable gastric banding.  World J Surg. 1998;  22 955-963
    CrossrefPubMedGoogle Scholar
  • 6 Belachew M, Belva P, Desaive C. Long-Term Results of laparoscopic adjustable gastric banding for treatment of morbid obesity.  Obes Surg. 2002;  12 564-568
    CrossrefPubMedGoogle Scholar
  • 7 Belachew M, Zimmermann J M. Evolution of a paradigm for laparoscopic adjustable gastric banding.  Am J Surg. 2002;  184 21 S-25 S
    PubMedGoogle Scholar
  • 8 Benecke A, Majenski J, Faller H. Gastric Banding als operative Behandlungsmethode für schwer übergewichtige Patienten - Psychologische Begleitforschung und erste Ergebnisse.  Z Klin Psychol Psychiat Psychother. 2000;  48 343-358
    PubMedGoogle Scholar
  • 9 Biertho L, Steffen R, Ricklin T, Horber F, Pomp A, Inabnet W, Herron D, Gagner M. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: A comparative study of 1 200 cases.  J Am Coll Surg. 2003;  4 536-547
    PubMedGoogle Scholar
  • 10 Buchmann P, Steuer J. Lernkurve in der Chirurgie. Möglichkeiten und Grenzen dieser Methode.  Swiss Surg. 2002;  8 106-109
    PubMedGoogle Scholar
  • 11 Buchwald H, Avidor Y, Braunwald E, Jensen M, Pories W, Fahrbach K, Schoelles K. Bariatric surgery. A systematic review and meta-analysis.  JAMA. 2004;  14 1724-1737
    PubMedGoogle Scholar
  • 12 Busetto L, Pisent C, Segato C. et al . Eating pattern in the first year following adjustable silicone gastric banding for morbid obesity.  Int J Obesity. 1995;  19 227-233
    PubMedGoogle Scholar
  • 13 Camerini G, Adami G, Marinari G M, Gianetta E, Pretolesi F, Papadia F, Marinari P, Murelli F, Carlini F, Stabilini C, Soriani M P, Scopinaro N. Thirteen years of follow-up in patients with adjustable silicone gastric banding for obesity: weight loss and constant rate of late specific complications.  Obes Surg. 2004;  14 1343-1348
    CrossrefPubMedGoogle Scholar
  • 14 Chapman A E, Kiroff G, Game P, Forster B, O'Brien P, Ham J, Maddern G J. Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review.  Surgery. 2004;  135 326-351
    CrossrefPubMedGoogle Scholar
  • 15 Chevallier J M, Zinzindohoue F, Douard R, Blanche J P, Berta J L, Altman J J, Cugnenc P H. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1 000 patients over 7 years.  Obes Surg. 2004;  14 407-414
    CrossrefPubMedGoogle Scholar
  • 16 Cowan G SM. A predict future for bariatric surgery: using the surgical model.  Obes Surg. 1996;  6 12-16
    CrossrefPubMedGoogle Scholar
  • 17 Dargent J. Laparoscopic adjustable silicone ring gastroplasty. A case of technical variation.  Eur J Coelio Surg. 1997;  3 4-8
    PubMedGoogle Scholar
  • 18 Dargent J. Laparsoscopic adjustable gastric banding: lessons from the first 500 patients in a single institution.  Obes Surg. 1999;  9 446-452
    CrossrefPubMedGoogle Scholar
  • 19 Dargent J. Pouch dilatation and slippage after adjustable gastric banding: is still an issue?.  Obes Surg. 2003;  13 111-115
    CrossrefPubMedGoogle Scholar
  • 20 Elmore U, Restuccia A, Perotta N, Polito D, De Leo A, Silecchia G, Basso N. Laparoscopic adjustable silicone gastric banding (LASGB): Analysis of 64 consecutive patients.  Obes Surg. 1998;  8 399
    PubMedGoogle Scholar
  • 21 Favretti F, Cadiere G B, Segato G. et al . Laparoscopic adjustable silicone gastric banding: how to avoid complications.  Obes Surgery. 1997;  7 352-358
    PubMedGoogle Scholar
  • 22 Favretti F, Cadiere G B, Segato G, De Marchi F. Lap-band for treatment of morbid obesity. A 6-year experience of 509 patients.  Obes Surg. 1999;  9 327
    PubMedGoogle Scholar
  • 23 Favretti F, Cadiere G B, Segato G, Busetto L, De Luca M, Caniato D, De Marchi F, Foletto M, Lise M, Enzi G. Lap-band: 7 year experience involving 830 patients (Abstract).  Obes Surg. 2001;  11 160
    PubMedGoogle Scholar
  • 24 Forsell P. Pouch volume, stoma diameter and weight loss in Swedish adjustable gastric banding (SAGB).  Obes Surg. 1996;  6 468-473
    CrossrefPubMedGoogle Scholar
  • 25 Francis K, Dewwer F, Vanrykel J P, Aelvoet C. Experience with laparoscopic gastric banding (lap-band system) up to 8 year.  Arch Chir Belg. 2005;  105 69-73
    PubMedGoogle Scholar
  • 26 Fried M, Miller K, Kormanova K. Literature review of comparative studies of complications with Swedish Band and Lap-Band®.  Obes Surg. 2004;  14 256-260
    CrossrefPubMedGoogle Scholar
  • 27 Granström L, Backman L. Technical complications and related reoperations after gastric banding.  Acta Chir Scand. 1997;  153 215-220
    PubMedGoogle Scholar
  • 28 Gustavsson S, Westling A. Laparoscopic adjustable gastric banding: complications and side effects responsible for poor long-term outcome.  Semin Laparosc Surg. 2002;  9 115-124
    CrossrefPubMedGoogle Scholar
  • 29 Hell E, Miller K. Morbide Adipositas. Ecomed Verlag, 2000
    Google Scholar
  • 30 Herpertz S, Kielmann R, Stang A, Siffert W, Wolf A M, Husemann B, Hulisz T, Stroh C, Machleit U, Chen-Stute A, Weiner R, Berg T, Kernen N, Senf W. Adipositas und psychische Komorbidität - Eine repräsentative Studie (Abstract).  Aktuel Ernaehr. 2002;  27 335
    PubMedGoogle Scholar
  • 31 Husemann B. Die chirurgische Therapie der extremen Adipositas.  DÄ. 1997;  33 1735-1739
    PubMedGoogle Scholar
  • 32 Keidar A, Szold A, Carmon E, Blanc A, Abu-Abeid S. Band slippage after adjustable gastric banding: etiology and treatment.  Surg Endosc. 2004;  11 262-267
    PubMedGoogle Scholar
  • 33 Kirby R M, Ismail T, Crowson M. et al . Gastric banding in the treatment of morbid obesity.  Br J Surg. 1989;  76 490-492
    PubMedGoogle Scholar
  • 34 Kuzmak L I. A review of seven years experience with silicone gastric banding.  Obes Surg. 1991;  1 403-408
    CrossrefPubMedGoogle Scholar
  • 35 Kuzmak L I, Thelmo W, Abramson D L. et al . Reversible adjustable gastric banding.  Eur J Surg. 1994;  160 571-596
    PubMedGoogle Scholar
  • 36 Lönroth H, Dälenbeck J, Haglind E, Josefson K, Olbe L, Fogerik Olsen M, Lundell L. Vertical banded gastroplasty by laparoscopic technique in treatment of morbid obesity.  Surg Laparosc Endosc. 1996;  6 102-107
    CrossrefPubMedGoogle Scholar
  • 37 Martikainen T, Pirinen E, Alhava E, Poikolainen E, Paakkonen M, Uusitupa M, Gylling H. Long-term results, late complications and quality of life in a series of adjustable gastric banding.  Obes Surg. 2004;  14 648-654
    CrossrefPubMedGoogle Scholar
  • 38 Mortele K J, Pattijn P, Mollet P, Berrevoet F, Hesse U, Ceelen W, Ros P R. The Swedish laparoscopic adjustable gastric banding for morbid obesity: Radiologic findings in 218 patients.  AJR. 2001;  177 77-84
    PubMedGoogle Scholar
  • 39 Niville E, Dams A. Late pouchdilatation after laparoscopic adjustable gastric and esophagastric banding: Incidence, treatment and outcome.  Obes Surg. 1999;  9 381-384
    CrossrefPubMedGoogle Scholar
  • 40 O'Brien P E, Brown M A, Smith A. et al . Prospective study of laparoscopically placed, adjustable gastric banding in the treatment of morbid obesity.  Br J Surg. 1999;  85 113-118
    PubMedGoogle Scholar
  • 41 O'Brien P E. Weight loss and early and late complications - the international experience.  Am J Surg. 2002;  184 42 S-45 S
    PubMedGoogle Scholar
  • 42 O'Brien P E, Dixon J B. Lap-Band: outcomes and results.  J Laparoendosc Adv Surg Tech [Am]. 2003;  13 265-270
    CrossrefPubMedGoogle Scholar
  • 43 Oria H E. Gastric Banding for morbid obesity.  Eur J Gastroenterol Hepatol. 1999;  11 105-114
    PubMedGoogle Scholar
  • 44 Rubenstein R B. Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year follow up.  Obes Surg. 2002;  12 380-384
    CrossrefPubMedGoogle Scholar
  • 45 Schmoller F, Sengstbratl M, Havlicek W, Krichbaumer K, Böhmig H J. Laparoscopic reoperations of adjustable silicone gastric banding.  Eur J Coelio Surg. 1999;  29 73
    PubMedGoogle Scholar
  • 46 Scopinaro N, Gianetta E, Adami G F, Friedman D, Traverso E, Marinari G M, Cueno S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V. Biliopancreatic diversion for obesity at eighteen years.  Surgery. 1996;  119 261
    CrossrefPubMedGoogle Scholar
  • 47 Sjöström L, Lindroos A K, Peltonen M, Torgerson J, Bouchard C, Carlson B, Dahlgren S, Larsson B, Narbro K, Sjöström C D, Sullivan M, Wedel H. Livestyle, diabetes and cardiovascular risk factor 10 years after bariatric surgery.  N Engl J Med. 2004;  351 2683-2693
    CrossrefPubMedGoogle Scholar
  • 48 Spivak H, Hewitt M F, Onn A, Half E E. Weight loss and improvement of obesity related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure.  Am J Surg. 2005;  189 27-32
    CrossrefPubMedGoogle Scholar
  • 49 Steffen R, Biertho L, Ricklin T, Piec G, Horber F. Laparoscopic adjustable Gastric Banding: a five year prospective study.  Obes Surg. 2003;  13 404-411
    CrossrefPubMedGoogle Scholar
  • 50 Stroh C, Schramm H. Report about the 4 year experience in the technique of gastric banding (Abstract).  Eur J Coelio Surg. 1999;  29 63
    PubMedGoogle Scholar
  • 51 Stroh C, Schramm H. Postoperative Kontrolle und Gewichtsverhalten nach Gastric Banding.  Zentralbl Chir. 2000;  125 682-687
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Stroh C, Hohmann U, Manger T. Management von Langzeitkomplikationen nach Gastric Banding.  J Ernährungsmed. 2004;  3 5-9
    PubMedGoogle Scholar
  • 53 Stroh C, Manger T. Studie zur operativen Therapie der Adipositas - Aufruf zur Teilnahme.  Dt Ges Chir Mitt. 2004;  4 389-391
    PubMedGoogle Scholar
  • 54 Suter M, Guisti V, Heraief E, Jayet C, Jayet A. Early results of laparoscopic gastric banding compared with open vertical banded gastroplasty.  Obes Surg. 1999;  9 374-380
    CrossrefPubMedGoogle Scholar
  • 55 Suter M. Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: Disappointing results.  Obes Surgery. 2001;  11 507-512
    PubMedGoogle Scholar
  • 56 Suter M, Bettschart V, Giusti V. A 3 year experience with laparoscopic gastric banding for morbid obesity.  Surg Endosc. 2000;  14 532-536
    CrossrefPubMedGoogle Scholar
  • 57 Suter M, Giusti V, Worreth M, Heraif E, Calmes J. Laparoscopic gastric banding. A prospective randomized study compairing the Lap-band and the SAGB: Early results.  Ann Surg. 2005;  1 55-62
    PubMedGoogle Scholar
  • 58 Szould A, Abu-Abeid S. Laparoscopic adjustable silicone gastric banding for morbid obesity: results and complications in 715 patients.  Surg Endosc. 2002;  16 230-233
    CrossrefPubMedGoogle Scholar
  • 59 Weiner R, Wagner D. Laparoskopisches Gastric Banding zur Behandlung Morbider Adipositas.  Minimal invasive Chir. 1997;  63 59-63
    PubMedGoogle Scholar
  • 60 Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid obesity.  J Laparoendosc Advanced Surg Techniques. 1999;  9 23-30
    PubMedGoogle Scholar
  • 61 Weiner R, Wagner D, Blanco-Engert R, Bockhorn H. Eine neue Technik zur laparoskopischen Platzierung des steuerbaren Magenbandes (LAP-Band) zur Vermeidung eines Slippage.  Chirurg. 2002;  71 1243-1250
    PubMedGoogle Scholar
  • 62 Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schäfer L, Pomhoff I. Outcome after laparoscopic adjustable gastric banding - 8 years experience.  Obes Surg. 2003;  13 427-434
    CrossrefPubMedGoogle Scholar
  • 63 Weiss H, Nehoda H D, Labeck B, Peer R, Aigner F. Gastroscopic band removal after intragastric migration of adjustable gastric band: A new minimal invasive technique.  Obes Surg. 2000;  10 167-170
    CrossrefPubMedGoogle Scholar
  • 64 Weiss H, Nehoda H D, Labeck B, Peer-Kühberger R, Klingler P, Gadenstätter M, Aigner F, Gerold G J. Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility.  Am J Surg. 2000;  180 479-482
    CrossrefPubMedGoogle Scholar
  • 65 Weiss H, Nehoda H D, Labeck B, Peer-Kuehberger R, Oberwalder M, Aigner F, Wetscher G J. Adjustable gastric and esophagogastric banding a randomized clinical trial.  Obes Surg. 2002;  12 573-578
    CrossrefPubMedGoogle Scholar
  • 66 Westling A, Bjurling K, Öhrvall M, Gustavson S. Silicone adjustable gastric banding. Disappointing results.  Obes Surg. 1998;  8 467-474
    PubMedGoogle Scholar
  • 67 Wiesner W, Weber M, Hauser R S, Schoeb O. Anterior versus posterior slippage: two different types of eccentric pouchdilatation in patients with adjustable laparoscopic gastric banding.  Dig Surg. 2001;  18 182-186
    CrossrefPubMedGoogle Scholar
  • 68 Wittgrove A, Clark W, Schubert K. Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3-30 month follow up.  Obes Surg. 1996;  6 500-504
    PubMedGoogle Scholar
  • 69 Wolff S. Magenbandpenetration - eine schwerwiegende Komplikation nach Gastric Banding?.  Zbl Chir. 2002;  127 1086-1090
    PubMedGoogle Scholar
  • 70 Zehetner J, Holzinger F, Triaca H, Klaiber C. A 6-year experience with Swedish adjustable gastric band. Prospective long-term audit of laparoscopic gastric banding.  Surg Endosc. 2004;  11 21-28
    PubMedGoogle Scholar

Dr. Christine Stroh

Departement für Allgemein- und Viszeralchirurgie · SRH Wald-Klinikum Gera gGmbH

Straße des Friedens 122

07548 Gera

Phone: 03 65/8 28 31 01

Fax: 03 65/8 28 31 02

Email: Christine.Stroh@wkg.srh.de

      >