Laparotomic vs laparoscopic lap-band: 4-year results with early and intermediate complications

Background: Adjustable banding is safe, low invasive, and effective for losing weight. Methods: 69 patients underwent this procedure by laparotomy or laparoscopy. Results: Patients operated by laparotomy lost more weight than those operated by laparoscopy, but in 4 patients we were forced to re-operate in order to remove the band (3 pouch dilatations and 1 stomach slippage), and in 9 patients a ventral hernia appeared (5 patients repaired). In the laparoscopic cases there were 4 intra-operative gastric perforations, but all were repaired and the band placed at the same time (3 conversions to open), causing an increased post-operative hospital stay. There was a lower limb deep venous thromboembolism, which was followed by fatal pulmonary embolism (although the patient had been given heparin and had been treated with elastocompression and mobilization 2 hours after surgery). The band eroded in one patient. Weight losses in these morbidly obese patients were satisfactory at 2 years and maintained beyond 3 years. Conclusion: Laparoscopic adjustable banding is an efficient, generally safe procedure.