SAN DIEGO — The risk of pouch dilatation may be lowered if weight is lost before surgery, according to a study of morbidly obese patients in the Netherlands, Karlijn J.P. van Wessem, M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.
An intensive preoperative weight loss program reduced mean body mass index (BMI) in 47 patients before laparoscopic banding, and only 1 patient (2%) developed pouch dilatation 10 months after surgery, said Dr. van Wessem of Reinier de Graff Hospital, Delft, the Netherlands. Complication rates of 6%–21% have been reported in the literature, she added.
A physician supervised patients with a mean BMI greater than 40 kg/m
Mean BMI was reduced from an initial 45 kg/m
Beyond 6 weeks after surgery, there were no significant changes in BMI during a relatively short mean follow-up of 18 months, out to 28 months in some patients. Because the mean BMI stayed relatively high, especially in men, the study's results raise questions about whether gastric banding is appropriate for all patients or whether tighter selection should exclude some, such as men, she said.
Complications developed in seven patients (15%), a rate comparable with those reported in the literature. Three developed gastric obstructions due to misplacement of the band. The cases were among the first 15 patients, so the problems might be attributed to the learning curve, she said. The bands were repositioned laparoscopically.
A port-site leakage was repaired in one patient. Two did not lose weight despite maximum filling of the band. Their bands were removed, and they'll undergo gastric bypass surgery later, Dr. van Wessem said.