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Original Article |

Value of Routine Postoperative Gastrographin Contrast Swallow Studies After Laparoscopic Gastric Banding FREE

Eldo E. Frezza, MD, MBA; Joseph G. Mammarappallil, PhD; Chance Witt, BS; Cai Wei, MD; Mitchell S. Wachtel, MD
[+] Author Affiliations

Author Affiliations: Department of Surgery, Division of General Surgery (Drs Frezza, Mammarappallil, and Wei and Mr Witt), and Department of Pathology (Dr Wachtel), Texas Tech University Health Sciences Center, Lubbock.


Arch Surg. 2009;144(8):766-769. doi:10.1001/archsurg.2009.138.
Text Size: A A A
Published online

Hypothesis  Laparoscopic adjustable gastric banding (LAGB) effectively treats morbid obesity and yields improved quality of life with low morbidity and mortality rates. The current standard of care is to perform a postoperative gastrographin study. This study evaluated a series of patients to determine the usefulness of this routine procedure.

Design  Retrospective analysis.

Setting  Texas Tech University Health Sciences Center, Lubbock.

Patients  A series of 100 patients who had undergone LAGB between August 1, 2006, and February 28, 2007, were evaluated by medical record review and a blinded examination of the upper gastrointestinal tract.

Main Outcome Measures  Laboratory test results and patient vital signs.

Results  The mean age of the patients was 42 years. The mean initial body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.0. Median excess weight loss was 49.0% after 12 months. Three patients did not undergo gastrographin studies because of a history of allergic reactions to the dye. No differences between the opinion of the surgeon and that of the original radiologist were uncovered. The 97 patients who underwent gastrographin studies lacked leaks; the only radiologic abnormalities were slow passage and reflux in 23 patients. No alteration in patient care resulted. The total cost for the 97 patients was $49 470. The 95% confidence interval for 0 useful results for 97 studies is 0.00 to 0.03; at best, 3.2% of patients undergoing this expensive study would have garnered some benefit.

Conclusion  Routine postoperative upper gastrointestinal tract studies are expensive and of limited value. Instead of relying on them to detect leaks, which are extremely rare after LAGB, reliance should be given to the presence or absence of tachypnea and tachycardia, as is currently done for Roux-en-Y gastric bypass. In this way there will be a cost savings and the potential to make LAGB a same-day procedure.

Laparoscopic adjustable gastric banding (LAGB) effectively treats morbid obesity and yields improved quality of life with low morbidity and mortality rates.17 A feared complication is a leak from the esophagus or stomach created by the dissection needed for placement of the band.812 The current protocol is to perform a postoperative gastrographin study to ensure proper band placement, appropriate passage of food through the stomach, and the absence of a leak,4,1214 but performance of this procedure remains controversial. We evaluated 100 patients who underwent consecutive LAGB procedures to test the hypothesis that this radiographic study adds no benefit to patient care.

The medical records of 100 consecutive patients who had undergone LAGB between August 1, 2006, and February 28, 2007, at Texas Tech University Health Sciences Center, Lubbock, were retrospectively evaluated after institutional review board approval. Patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) greater than 40, with or without comorbidities, and those with a body mass index of 35 to 40 were candidates for LAGB (Table 1). All patients underwent routine preoperative medical and surgical evaluations, preoperative upper gastrointestinal (GI) tract endoscopic examinations, preoperative esophageal manometric studies, and mechanical evaluation. Follow-up of the patients was performed for 24 hours to evaluate signs of tachycardia and tachypnea. Postoperatively, we evaluated a series of blood tests and vital signs to match with potential upper GI tract abnormalities (Table 2). A liquid diet was instituted on postoperative day 1. The morning after surgery, each patient who did not have a contraindication for a radiologic examination experienced an upper GI tract radiologic examination with gastrographin (Omnipaque; GE Healthcare Services, Chalfont St Giles, England) at a concentration of 300 mg/mL; 30 to 50 mL was swallowed by the patient while standing, after which radiographic images were taken every 2 to 4 seconds. Follow-up images were obtained in both the anteroposterior and left oblique projections at the level of the port and band site. On the morning of the upper GI examination, the surgeon independently read the upper GI tract report at the end of the study and compared it with the radiologic report written by the attending radiologist. Therefore, the surgeon knew about the clinical situation but did not know about the report of the radiologist and the findings of the upper GI tract report because the report had been written by the radiologist after the surgeon had read the study. In this type of reading, the radiologist overestimated some of the reflux and stasis conditions. There was only an 83.0% concordance between the 2 readings.

Table Graphic Jump LocationTable 1. Characteristics of the 100 Study Patients
Table Graphic Jump LocationTable 2. Comparison of Patients With Normal Upper GI Tract Examination Results vs Those With Reflux or Stasisa

The data were collected independently by 2 medical students (C.W. and J.G.M.), and the radiographs were interpreted independently by the surgical and radiologic attending physicians. Costs were obtained from the medical records of the patient. The 95% confidence interval for the proportion of patients who might have had an alteration in patient care from the study was calculated by the use of an online calculator.15

Of 100 patients who underwent LAGB, 88 were women. The mean age of the patients was 42 years. The mean initial body mass index was 50.1. The demographics are reported in Table 1. We evaluated laboratory test results and vital signs for each patient, and the results are reported in Table 2. Median excess weight loss was 49.0% after 12 months. Three patients did not undergo gastrographin studies because of a history of allergic reactions to the dye. No differences between the opinion of the surgeon and that of the original radiologist were uncovered. The 97 patients who underwent gastrographin studies lacked leaks; the only radiologic abnormalities were slow passage and reflux in 23 patients. No alteration in patient care resulted. Each study yielded a technical fee charge of $400 and a radiologist bill of $110 for a total of $510 per patient and $49 470 for all 97 patients. The 95% confidence interval for 0 useful results for 97 studies is 0.00 to 0.03; at best, 3% of patients undergoing this expensive study would have garnered some benefit.

This study found that 97 consecutive upper GI tract examinations at a total cost of $49 470 yielded no results that altered patient care. Devised in 1983 and put into practice in 1993, LAGB was the first bariatric procedure that added an element of adjustability to the armamentarium of the bariatric surgeon.1519 The procedure produces low morbidity and mortality rates,8,9,20,21 with only approximately one-third of patients experiencing problems.22 Approximately 1 in 10 patients require additional surgery in the immediate postoperative period.811,2225 Early complications include band malpositioning, perforation, stomal obstruction, regurgitation, and pouch esophageal reflux; late complications include band herniation, band migration, slippage, port dilatation, port infection, and erosion.812,2133 In 1% of the patients there is improper positioning of the band at surgery30 and early slippage.8,9,11,23 Stomal obstruction may occur in 1.4% of patients, but most of the time this does not require surgery and the medical therapy is sufficient.25 Dysphagia can occur in 14% of patients,21 and regurgitation and pouch esophageal reflux are common and usually resolve with dietary change.12 In the long term, complications include pouch dilatation and slippage of the gastric band.11,12,21,22,30 These complications require a diagnostic tool, such as fluoroscopy.12,21 Other complications, such as intragastric erosion with secondary obstruction, potential leak, and system infection, require surgery.25,26,31 Gastric necrosis occurs in 0.3% of the patients.810

Gastroesophageal perforation occurs in less than 0.5% of patients812; leaks are usually related to the operative technique and are the most severe immediate postoperative complication. The severity of this complication has rendered postoperative upper GI tract radiologic examinations with gastrographin the standard of care. The rarity of this complication renders somewhat dubious the benefits of performance of a study that costs more than $500 per patient and sometimes fails to detect leaks.34 Moreover, the radiologic study places the patient at risk for aspiration pneumonia, although the exact incidence of these complications has not been determined. Apart from detection of leaks, there is little reason to order such a radiologic study. Radiologic demonstration of free passage of food through the stomach is not mandatory in the postoperative follow-up.35,36 Apart from leaks, all other abnormalities that might be detected by this study are managed without surgery and then only if symptoms that would lead to their detection are bothersome; their radiologic postoperative identification does not serve to advance patient care. Only a potential leak has to be repaired surgically; all others can be treated medically.

In our study, we also evaluated whether there was any correlation between upper GI tract abnormalities and blood test results, such as complete blood cell counts and electrolyte levels, and vital signs, such as blood pressure, heart rate, and oxygenation. As reported in Table 2, no notable differences were found in patients with reflux or stasis. We cannot comment on leaks because we did not have any. Seven patients were seen in the office or in the emergency department for nausea and dehydration, but no correlation was found with previous upper GI tract procedures. For other bariatric procedures, such as Roux-en-Y gastric bypass (RYGBP) and duodenal switch, the best monitor is nonradiologic: tachycardia and tachypnea are sufficiently sensitive to allow surgeons to rely on them to determine when and if a leak should occur and are sufficiently specific to warrant a subsequent operation without any other study.3742 In our study, we did not have tachycardia or tachypnea, and we did not find any leaks of contrast. We therefore recommend following up the patient for 24 hours for tachycardia and tachypnea. Only a few have recommended routine use of a radiologic study on postoperative day 1 after RYGBP.4346 Given that the chances of leak after LAGB are much lower than after RYGBP, the rationale for the utility of this expensive study is almost nonexistent in LAGB. An upper GI tract examination can be “selective” by the use of patients who continue to have symptoms, such as tachycardia and tachypnea, or who have a hard time swallowing clear fluid the day after the operation because the examination reveals band tightness and any potential inflammation that probably need to be treated. Patients who have these problems might require longer hospitalization and intravenous fluids before we discharge them postoperatively. Unexplained tachycardia, fever, abdominal pain, elevated white blood cell count, and low urine output are also potential indications of upper GI tract issues.

In conclusion, routine postoperative upper GI tract radiologic studies are expensive and of limited value. Instead of relying on them to detect leaks, which are extremely rare after LAGB, reliance should be given to the presence or absence of tachypnea and tachycardia, as is currently done for RYGBP.

Correspondence: Eldo E. Frezza, MD, MBA, Division of General Surgery, Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th St, MS 8312, Lubbock, TX 79430 (eefrezza@msn.com).

Accepted for Publication: July 18, 2008.

Author Contributions:Study concept and design: Frezza and Mammarappallil. Acquisition of data: Mammarappallil, Witt, and Wei. Analysis and interpretation of data: Frezza, Mammarappallil, Witt, and Wachtel. Drafting of the manuscript: Frezza, Wei, and Wachtel. Critical revision of the manuscript for important intellectual content: Frezza, Mammarappallil, and Wachtel. Statistical analysis: Wachtel. Administrative, technical, and material support: Frezza, Mammarappallil, and Witt. Study supervision: Frezza.

Financial Disclosure: None reported.

Forsell  PHallberg  DHellers  G Gastric banding for morbid obesity: initial experience with a new adjustable band. Obes Surg 1993;3 (4) 369- 374
PubMed Link to Article
Forsell  PHellers  G The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year experience and a 4-year follow-up of patients operated with a new adjustable band. Obes Surg 1997;7 (4) 345- 351
PubMed Link to Article
Nehoda  HWeiss  HLabeck  B  et al.  Results and complications after adjustable gastric banding in a series of 250 patients. Am J Surg 2001;181 (1) 12- 15
PubMed Link to Article
O’Brien  PEBrown  WASmith  A McMurrick  PJStephens  M Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 1999;86 (1) 113- 118
PubMed Link to Article
Parikh  MSFielding  GARen  CJUS Experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc 2005;19 (12) 1631- 1635
PubMed Link to Article
Belachew  MLegrand  MJVincent  VLismonde  MLe Docte  NDeschamps  V Laparoscopic adjustable gastric banding. World J Surg 1998;22 (9) 955- 963
PubMed Link to Article
Klaiber  CMetzger  AForsell  P Laparoscopic gastric banding [in German]. Chirurg 2000;71 (2) 146- 151
PubMed
DeMaria  EJJamal  MK Laparoscopic adjustable gastric banding: evolving clinical experience. Surg Clin North Am 2005;85 (4) 773- 787, vii
PubMed Link to Article
Chevallier  J-MZinzindohoué  FDouard  R  et al.  Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg 2004;14 (3) 407- 414
PubMed Link to Article
Zinzindohoué  FChevallier  JMDouard  R  et al.  Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg 2003;237 (1) 1- 9
PubMed Link to Article
Favretti  FCadière  GBSegato  G  et al.  Laparoscopic banding: selection and technique in 830 patients. Obes Surg 2002;12 (3) 385- 390
PubMed Link to Article
Wiesner  WSchöb  OHauser  RSHauser  M Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology 2000;216 (2) 389- 394
PubMed Link to Article
Hell  EMiller  K Laparosckopiches gastric banding. Hell  EMiller  KMorbide Adipositas. Landsberg, Germany Ecomed Publishers2000;139
Angrisani  LLorenzo  MSantoro  TNicodemi  OPersico  GTesauro  B Videolaparoscopic treatment of gastric banding complications. Obes Surg 1999;9 (1) 58- 62
PubMed Link to Article
 Causa Scientia Web site. www.causascientia.org/. Accessed June 10, 2008 
Kuzmak  L A preliminary report on silicone gastric banding for morbid obesity. Clin Nutr 1986;573- 77
Kuzmak  LI A review of seven years' experience with silicone gastric banding. Obes Surg 1991;1 (4) 403- 408
PubMed Link to Article
Forsell  P Pouch volume, stoma diameter and weight loss in Swedish adjustable gastric banding (SAGB). Obes Surg 1996;6 (6) 468- 473
PubMed Link to Article
Schlumpf  RLang  TSchöb  O  et al.  Treatment of the morbidly obese patient with laparoscopic adjustable gastric banding. Dig Surg 1997;14438- 443
Link to Article
Lise  MFavretti  FBelluco  C  et al.  Stoma adjustable silicone gastric banding: results in 111 consecutive patients. Obes Surg 1994;4 (3) 274- 278
PubMed Link to Article
Szucs  RATurner  MAKellum  JMDeMaria  EJSugerman  HJ Adjustable laparoscopic gastric band for the treatment of morbid obesity: radiologic evaluation. AJR Am J Roentgenol 1998;170 (4) 993- 996
PubMed Link to Article
Zacharoulis  DRoy-Chadhury  SHDobbins  B  et al.  Laparoscopic adjustable gastric banding: surgical and radiological approach. Obes Surg 2002;12 (2) 280- 284
PubMed Link to Article
Suter  MGiusti  VWorreth  MHéraief  ECalmes  J-M Laparoscopic gastric banding: a prospective randomized study comparing the Lapband and the SAGB: early results. Ann Surg 2005;241 (1) 55- 62
PubMed
Weiner  RBlanco-Engert  RWeiner  SMatkowitz  RSchaefer  LPomhoff  I Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg 2003;13 (3) 427- 434
PubMed Link to Article
Abu-Abeid  SSzold  A Results and complications of laparoscopic adjustable gastric banding: an early and intermediate experience. Obes Surg 1999;9 (2) 188- 190
PubMed Link to Article
Ponce  JPaynter  SFromm  R Laparoscopic adjustable gastric banding: 1,014 consecutive cases. J Am Coll Surg 2005;201 (4) 529- 535
PubMed Link to Article
Zengin  KSen  BOzben  VTaskin  M Detachment of the connecting tube from the port and migration into jejunal wall. Obes Surg 2006;16 (2) 206- 207
PubMed Link to Article
Pomerri  FLiberati  LCurtolo  SMuzzio  PC Adjustable silicone gastric banding for obesity. Gastrointest Radiol 1992;17 (3) 207- 210
PubMed Link to Article
Favretti  FCadiere  GBSegato  G  et al.  Laparoscopic adjustable silicone gastric banding (Lap-Band®): how to avoid complications. Obes Surg 1997;7 (4) 352- 358
PubMed Link to Article
Chelala  ECadiere  GBFavretti  F  et al.  Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases. Surg Endosc 1997;11 (3) 268- 271
PubMed Link to Article
Hartmann  JScharfenberg  MPaul  MAblassmaier  B Intracolonic penetration of the laparoscopic adjustable gastric banding tube. Obes Surg 2006;16 (2) 203- 205
PubMed Link to Article
Zappa  MAMicheletto  GLattuada  E  et al.  Prevention of pouch dilatation after laparoscopic adjustable gastric banding. Obes Surg 2006;16 (2) 132- 136
PubMed Link to Article
Weiss  HNehoda  HLabeck  BPeer  RAigner  F Gastroscopic band removal after intragastric migration of adjustable gastric band: a new minimal invasive technique. Obes Surg 2000;10 (2) 167- 170
PubMed Link to Article
Weiss  HNehoda  HLabeck  BHourmont  KLanthaler  MAigner  F Injection port complications after gastric banding: incidence, management and prevention. Obes Surg 2000;10 (3) 259- 262
PubMed Link to Article
Buckwalter  JAHerbst  CA  Jr Leaks occurring after gastric bariatric operations. Surgery 1988;103 (2) 156- 160
PubMed
Hauri  PSteffen  RRicklin  TRiedtmann  HJSendi  PHorber  FF Treatment of morbid obesity with the Swedish adjustable gastric band (SAGB): complication rate during a 12-month follow-up period. Surgery 2000;127 (5) 484- 488
PubMed Link to Article
Nehoda  HHourmont  KMittermair  R  et al.  Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory? Obes Surg 2001;11 (5) 600- 604
PubMed Link to Article
Doraiswamy  ARasmussen  JJPierce  JFuller  WAli  MR The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 2007;21 (12) 2159- 2162
PubMed Link to Article
Sims  TLMullican  MAHamilton  ECProvost  DAJones  DB Routine upper gastrointestinal Gastrografin® swallow alter laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13 (1) 66- 72
PubMed Link to Article
Frezza  EE New concepts of physiology in obese patients. Dig Dis Sci 2004;49 (6) 1062- 1064
PubMed Link to Article
Dallal  RMBailey  LNahmias  N Back to basics—clinical diagnosis in bariatric surgery: routine drains and upper GI series are unnecessary. Surg Endosc 2007;21 (12) 2268- 2271
PubMed Link to Article
Kolakowski  S  JrKirkland  MLSchuricht  AL Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass: determination of whether it is necessary. Arch Surg 2007;142 (10) 930- 934
PubMed Link to Article
White  SHan  SHLewis  C  et al.  Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008;4 (2) 122- 125
PubMed Link to Article
Szomstein  SKaidar-Person  ONaberezny  KCruz-Correa  MRosenthal  R Correlation of radiographic and endoscopic evaluation of gastrojejunal anastomosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2 (6) 617- 621
PubMed Link to Article
Raman  RRaman  BRaman  P  et al.  Abnormal findings on routine upper GI series following laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007;17 (3) 311- 316
PubMed Link to Article
Serafini  FAnderson  WGhassemi  PPoklepovic  JMurr  MM The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass. Obes Surg 2002;12 (1) 34- 38
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 1. Characteristics of the 100 Study Patients
Table Graphic Jump LocationTable 2. Comparison of Patients With Normal Upper GI Tract Examination Results vs Those With Reflux or Stasisa

References

Forsell  PHallberg  DHellers  G Gastric banding for morbid obesity: initial experience with a new adjustable band. Obes Surg 1993;3 (4) 369- 374
PubMed Link to Article
Forsell  PHellers  G The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year experience and a 4-year follow-up of patients operated with a new adjustable band. Obes Surg 1997;7 (4) 345- 351
PubMed Link to Article
Nehoda  HWeiss  HLabeck  B  et al.  Results and complications after adjustable gastric banding in a series of 250 patients. Am J Surg 2001;181 (1) 12- 15
PubMed Link to Article
O’Brien  PEBrown  WASmith  A McMurrick  PJStephens  M Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 1999;86 (1) 113- 118
PubMed Link to Article
Parikh  MSFielding  GARen  CJUS Experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc 2005;19 (12) 1631- 1635
PubMed Link to Article
Belachew  MLegrand  MJVincent  VLismonde  MLe Docte  NDeschamps  V Laparoscopic adjustable gastric banding. World J Surg 1998;22 (9) 955- 963
PubMed Link to Article
Klaiber  CMetzger  AForsell  P Laparoscopic gastric banding [in German]. Chirurg 2000;71 (2) 146- 151
PubMed
DeMaria  EJJamal  MK Laparoscopic adjustable gastric banding: evolving clinical experience. Surg Clin North Am 2005;85 (4) 773- 787, vii
PubMed Link to Article
Chevallier  J-MZinzindohoué  FDouard  R  et al.  Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg 2004;14 (3) 407- 414
PubMed Link to Article
Zinzindohoué  FChevallier  JMDouard  R  et al.  Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg 2003;237 (1) 1- 9
PubMed Link to Article
Favretti  FCadière  GBSegato  G  et al.  Laparoscopic banding: selection and technique in 830 patients. Obes Surg 2002;12 (3) 385- 390
PubMed Link to Article
Wiesner  WSchöb  OHauser  RSHauser  M Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology 2000;216 (2) 389- 394
PubMed Link to Article
Hell  EMiller  K Laparosckopiches gastric banding. Hell  EMiller  KMorbide Adipositas. Landsberg, Germany Ecomed Publishers2000;139
Angrisani  LLorenzo  MSantoro  TNicodemi  OPersico  GTesauro  B Videolaparoscopic treatment of gastric banding complications. Obes Surg 1999;9 (1) 58- 62
PubMed Link to Article
 Causa Scientia Web site. www.causascientia.org/. Accessed June 10, 2008 
Kuzmak  L A preliminary report on silicone gastric banding for morbid obesity. Clin Nutr 1986;573- 77
Kuzmak  LI A review of seven years' experience with silicone gastric banding. Obes Surg 1991;1 (4) 403- 408
PubMed Link to Article
Forsell  P Pouch volume, stoma diameter and weight loss in Swedish adjustable gastric banding (SAGB). Obes Surg 1996;6 (6) 468- 473
PubMed Link to Article
Schlumpf  RLang  TSchöb  O  et al.  Treatment of the morbidly obese patient with laparoscopic adjustable gastric banding. Dig Surg 1997;14438- 443
Link to Article
Lise  MFavretti  FBelluco  C  et al.  Stoma adjustable silicone gastric banding: results in 111 consecutive patients. Obes Surg 1994;4 (3) 274- 278
PubMed Link to Article
Szucs  RATurner  MAKellum  JMDeMaria  EJSugerman  HJ Adjustable laparoscopic gastric band for the treatment of morbid obesity: radiologic evaluation. AJR Am J Roentgenol 1998;170 (4) 993- 996
PubMed Link to Article
Zacharoulis  DRoy-Chadhury  SHDobbins  B  et al.  Laparoscopic adjustable gastric banding: surgical and radiological approach. Obes Surg 2002;12 (2) 280- 284
PubMed Link to Article
Suter  MGiusti  VWorreth  MHéraief  ECalmes  J-M Laparoscopic gastric banding: a prospective randomized study comparing the Lapband and the SAGB: early results. Ann Surg 2005;241 (1) 55- 62
PubMed
Weiner  RBlanco-Engert  RWeiner  SMatkowitz  RSchaefer  LPomhoff  I Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg 2003;13 (3) 427- 434
PubMed Link to Article
Abu-Abeid  SSzold  A Results and complications of laparoscopic adjustable gastric banding: an early and intermediate experience. Obes Surg 1999;9 (2) 188- 190
PubMed Link to Article
Ponce  JPaynter  SFromm  R Laparoscopic adjustable gastric banding: 1,014 consecutive cases. J Am Coll Surg 2005;201 (4) 529- 535
PubMed Link to Article
Zengin  KSen  BOzben  VTaskin  M Detachment of the connecting tube from the port and migration into jejunal wall. Obes Surg 2006;16 (2) 206- 207
PubMed Link to Article
Pomerri  FLiberati  LCurtolo  SMuzzio  PC Adjustable silicone gastric banding for obesity. Gastrointest Radiol 1992;17 (3) 207- 210
PubMed Link to Article
Favretti  FCadiere  GBSegato  G  et al.  Laparoscopic adjustable silicone gastric banding (Lap-Band®): how to avoid complications. Obes Surg 1997;7 (4) 352- 358
PubMed Link to Article
Chelala  ECadiere  GBFavretti  F  et al.  Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases. Surg Endosc 1997;11 (3) 268- 271
PubMed Link to Article
Hartmann  JScharfenberg  MPaul  MAblassmaier  B Intracolonic penetration of the laparoscopic adjustable gastric banding tube. Obes Surg 2006;16 (2) 203- 205
PubMed Link to Article
Zappa  MAMicheletto  GLattuada  E  et al.  Prevention of pouch dilatation after laparoscopic adjustable gastric banding. Obes Surg 2006;16 (2) 132- 136
PubMed Link to Article
Weiss  HNehoda  HLabeck  BPeer  RAigner  F Gastroscopic band removal after intragastric migration of adjustable gastric band: a new minimal invasive technique. Obes Surg 2000;10 (2) 167- 170
PubMed Link to Article
Weiss  HNehoda  HLabeck  BHourmont  KLanthaler  MAigner  F Injection port complications after gastric banding: incidence, management and prevention. Obes Surg 2000;10 (3) 259- 262
PubMed Link to Article
Buckwalter  JAHerbst  CA  Jr Leaks occurring after gastric bariatric operations. Surgery 1988;103 (2) 156- 160
PubMed
Hauri  PSteffen  RRicklin  TRiedtmann  HJSendi  PHorber  FF Treatment of morbid obesity with the Swedish adjustable gastric band (SAGB): complication rate during a 12-month follow-up period. Surgery 2000;127 (5) 484- 488
PubMed Link to Article
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