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

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

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

4. 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

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/m2

7. 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.

8. 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

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

11. 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%

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

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

20. Before LAGB
After LAGB

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

22. “Thank you for your attention”