Postoperative Kontrolle und Gewichtsverhalten nach Gastric Banding

 

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Complications after gastric banding

Summary

Background: Since 1983 gastric banding has become a proven operative method, which reduces effectively excess weight in morbid obesity. Gastric banding has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here our 4 year experiences of gastric banding with special reference to complications.
Patients and methods: There were 109 patients in total, of whom 92 were women. Median age was 41.5 years (range 17-62 years) and median body-mass-index (BMI) was 49.6 kg/m² (range 36.7-82.6 kg/m²). From February 1995 to June 1997 39 patients were operated upon with the open technique. In June 1997 we started the laparoscopic gastric banding. 70 patients were treated with this method from June 1997 to February 1999.
Results: The weight loss 6 months postoperatively after gastric banding was 35.3 % and 12 months after the operation 43.0 % of the overweight. In 17 cases a re-operation was necessary. Indications for re-operations included pouch dilatation in 4 cases, slippage in 3 cases and complications connected with the port system. The operation technique and the kind of band fixation influenced the frequency of complications.
Conclusions: A lot of complications especially after laparoscopic gastric banding can be prevented by a strong indication. Using the laparoscopic technique complications like pouch dilatation are diminished compared to the open technique. A standardized operation technique decreases the complication and re-operation rate. Conversions to the open technique were mostly necessary during the learning curve of LASGB (laparoscopic adjustable silicone gastric banding).

Zusammenfassung

Hintergrund: Die 1983 eingeführte Methode des Gastric Banding ist ein Verfahren, welches bei morbider Adipositas zu einer dauerhaften und erfolgreichen Gewichtsreduktion führt und minimal-invasiv durchgeführt werden kann. Wir berichten über unsere Erfahrungen insbesondere im Hinblick auf intra- und postoperative Komplikationen.
Patienten und Methode: Seit 1995 wurde bei 109 Patienten, wovon 92 Patienten weiblich waren, ein Gastric Banding durchgeführt. Das mittlere Alter der Patienten betrug 41,5 Jahre (17-62 Jahre) und der mittlere BMI 49,6 kg/m² (36,7-82,6 kg/m²). Von Februar 1995 bis Juni 1997 wurden 39 Patienten offen chirurgisch operiert. Seit Juni 1997 führen wir die Operation laparoskopisch durch.
Ergebnisse: Der Übergewichtsverlust beträgt 6 Monate postoperativ 35,3 % und nach 12 Monaten 43,0 %. In 17 Fällen war eine operative Revision erforderlich. Indikationen stellten das Slippage, die Pouchdilatation, die Banddiskonnektion und Portkomplikationen dar. Die Operationstechnik, die Art der Bandfixation und die Portlokalisation beeinflussen die Komplikationsrate erheblich.
Schlußfolgerung: Eine Vielzahl von Komplikationen insbesondere nach laparoskopischen Gastric Banding können durch eine strenge Indikationsstellung, Auswahl der Patienten und exakte Operationstechnik reduziert werden.

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Dr. Christine Stroh

Departement für Allgemeine-, Viszerale- und Kinderchirurgie
Chirurgisches Zentrum Wald-Klinikum Gera gGmbH

Straße des Friedens 122

D-07548 Gera