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

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

3. Epidemiology of Obesity WorldwideIran WHO report 2010 35% of the world population WHO report 2011 Overweight 51.4% Obese 19.4%

4. Case Selection 18.5 < BMI < 25Normal 25 <BMI < 30OverweightDiet, Exercise, Medical Treatment 30 < BMI < 35Obesity Grade IDiet, Exercise, Balloon 35 <BMI < 40Obesity Grade IIGastric Banding/Plication 40 < BMI < 45Obesity Grade IIISleeve Gastrectomy BMI > 45Super Obese Balloon  Gastric Bypass

5. 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

6. 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/m 2

7. Demographic Data Mean Age 32.8  0.7 years Mean Initial BMI 37  0.3 kg/m 2 Mean BMI after surgery 29.4  0.3 kg/m 2 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.

8. Outcome of Comorbidities Number of Comorbidities Complete Remission Relative Remission No change Getting Worse Dyslipidemia144730 Diabetes71600 Hypertension63120 Sleep Apnea42110 Fatty Liver33000 Degenerative Joint Disease 21010

9. Early Gastric Banding Complications ▫Bleeding ▫Perforation

10. 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

11. Complications Frequency (%)LiteratureManagement No Complications126 (76.3)- Early Port Infection8 (4.8%)Conservative Late Port Infection3 (1.8%)1.8%Band Removal Anterior Prolapse13 (7.8%)1-22%Conservative Slippage8 (4.8%)1-22%Band Repair Erosion6 (3.6%)0-11%Band Removal Phrenic Nerve Irritation1 (0.6%)Band Removal Pouch Enlargement012%

12. Comparison of the complications between the patients with BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 BMI < 40 kg/m 2 (n=119) BMI ≥ 40 kg/m 2 (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 10

13. Port Infection

14. Slippage

15. Prolapse

16. Erosion

17. Opening of the gastric band clips (X-Ray)

18. Opening of the gastric band clips

19. Replacing the Gastric Band

23. Before LAGBAfter LAGB

24. What to do in order to decrease the complication rate? Proper case-selection Considering the sterility principles Changing eating habits in patients Avoiding vomiting

25. “Thank you for your attention”