Silicone-adjustable gastric banding: Disappointing results

Background: Silicone-adjustable Gastric banding (SAGB) has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here our 3-year experience of SAGE with special reference to complications and side-effects. Methods: There were 90 patients in total, of whom 72 were women. Median age was 42 (range, 20-63) years and median body mass index (BMI) was 43 (range, 34-57) kg/m(2). Laparoscopy was attempted to position the band in 63 cases but had to be converted to laparotomy in 16 (25%). Twenty-seven patients were laparotomized. We used the Swedish band (AB Obtech) throughout the series. In addition to regular clinic visits, patients were followed-up with upper gastrointestinal series 6 months postoperatively and gastroscopy after 2 years or earlier when symptomatic. Results: Median BMI decreased to 32 kg/m(2) after 12 months and to 31 kg/(m)2 after 24 months. With a median follow-up time of 35 months (range, 22-48), 32 patients (35%) have been re-operated usually with removal of the balloon system and conversion into a Roux-en-Y gastric bypass. The most common reasons for re-operation were band erosion (n = 10) and erosive esophagitis (n = 14). Additional indications for re-operation included pouch dilatation, invagination of distal gastric wall through the band, leakage from the balloon, patient dissatisfaction, and severe allergic reaction. When questioned 2 years postoperatively more than half of the patients reported vomiting, heartburn and regurgitation but 78% still pronounced themselves satisfied with the operation. Esophagitis was found in 56% of the patients at gastroscopy after 2 years. Conclusion: SAGE could be positioned with laparoscopy in 75% of the cases but the incidence of complications and side-effects postoperatively has been high. (C) 1998 Lippincott-Raven Publishers.