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Chirurgia 2000 February;13(1):57-62

language: Italian

Laparoscopic adjustable gastric banding: the ''learning curve'' period

Silecchia G., Elmore U., Restuccia A., Polito D., Perrotta N., Bacci V., Basso M. S., Cuzzolaro M., Basso N.


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Background. The laparoscopic adjustable silicone gastric banding (LASGB) is the most diffuse bariatric procedure in Europe. The aim of the present paper was to analyze the patient¹s selection/follow-up carried out by a multidisciplinar staff and the ³learning curve² period.
Methods. Between January 1996-February 1999, 460 patients were evaluated by the multidisciplinary staff and 105 consecutive patients (79 F, 26 M) mean age 38.6 (20-62) years, mean weight 119.7 (89-170) kg, mean BMI 44.3 (35-57.3) kg/m2, underwent LASGB. The Lap Band® McGhan-BioEnterics was looped around the stomach, thus creating a 15-20 ml pouch. At the end of the operation the band was always deflated.
Results. The most frequent causes of exclusion were: BMI (< 35 or > 50) and the age (< 18 or > 65 yrs) (33%), psychiatric disorders (12%), large hiatal hernia (8%). The conversion rate was 3.8%. One patient died on the 2nd p.o. day for pulmonary embolism. The mean operative time was 106 min (45-180). The mean hospital stay was 2.5 days (1-9). The incidence of major specific complications was 5.7%: one stomach slippage (15 days p.o.); one pouch dilatation (12 months p.o.); four band migration (6-18 months p.o.). One band was removed for psychological reason. Five bands have been successfully removed by minimally-invasive approach.
Conclusions. The incidence of major complications was 5.7% and all but one occurred during the ³learning curve² period (1-30 patients). The multidisciplinary selection allowed an earlier detection of the band-related complications and to improve patients compliance.

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