Complications Associated with Laparoscopic Adjustable Gastric Banding for Morbid Obesity Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami Dr. Mahmoud KaramiRad 2012, May 9th

Definition of Obesity BMI ≥ 30 Excess weight more than 20% of Ideal Body Weight

Epidemiology of Obesity Worldwide Iran WHO report 2011 Overweight 51.4% Obese 19.4% WHO report 2010 35% of the world population

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 BalloonGastric 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 32.80.7 years 370.3 kg/m2 29.40.3 kg/m2 Mean Age 32.80.7 years Mean Initial BMI 370.3 kg/m2 Mean BMI after surgery 29.40.3 kg/m2 Mean Operation Time 20.12.3 minutes Mean Hospital Stay 17.80.8 hours Mean Time to Return to Work 6.10.4 days Mean Follow-up Period 16.90.9 months Median of % of weight loss (%WL) 20.5 % Median Excess Body Weight Loss (EBWL) 32 %, Mean Weight Reduction 21.40.9 kg.

Outcome of Comorbidities Number of Comorbidities Complete Remission Relative Remission No change Getting Worse Dyslipidemia 14 4 7 3 Diabetes 1 6 Hypertension 2 Sleep Apnea Fatty Liver Degenerative Joint Disease

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 Opening of the gastric band clips Pouch Enlargement Acute obstruction due to band connection tube

Complications Frequency (%) 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% Slippage Band Repair Erosion 6 (3.6%) 0-11% Phrenic Nerve Irritation 1 (0.6%) Pouch Enlargement 12%

Comparison of the complications between the patients with BMI < 40 kg/m2 and BMI ≥ 40 kg/m2 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) Erosion 3 (2.6) Phrenic Nerve Irritation 1

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”