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45. Silicone Adjustable Gastric Banding For Morbid Obesity. Systematic Review Update, Jan. 1999-May 2000 Horacio E Oria, MD, FACS Private Practice, Spring Branch Medical Center, Houston, TX, USA Background'. A systematic analysis of the literature on adjustable gastric banding (1966 to Dec. 1998) was presented at several meetings and published in Obes Surg 1999; 9: 133-4. The main conclusion was that the data was insufficient to analyze objectively the merits of this technique. Although manufacturing- related problems and intraoperative complications had diminished overtime, the incidence of complications and reoperations remained high. Moreover, long-term follow-up and data on weight-loss were inadequate. This update compiles the recent publications, compares the data with the previous review, and analyzes the quality of the papers and reporting of outcomes. Methods: Publications in English were identified through a MEDLINE (Jan.1999-May 2000) literature search. The inclusion and exclusion criteria were the same as in the first review. A minimum of 40 cases and 1 year of follow-up was required, as well as data on technique, early and late morbidity, mortality, reoperations and weight loss. The latest paper by the same authors was selected. Poster presentations and videos were not included. Two Italian registries series will be discussed separately. The outcomes were tabulated, summarized and compared with the information collected for the first analysis. Results: 166 studies (43 articles,123 abstracts) were reviewed. Obesity Surgery published 102. Other 54 were mostly abstracts from the 1st. ISLOS meeting (Naples, Italy, 1999). Only 10 appeared in other journals. Alarmingly, 35 papers (21%) dealt specifically with complications of this technique. Inclusion criteria were met in 38 publications. Repeated presentations were excluded, leaving 23 studies from 11 countries for final analysis. A total of 4956 patients (82% females) were operated, 88% by laparoscopy. The American-made adjustable band was used in 76.3%, the Swedish in 15.4%. Unknown type of band in 6.8%, InamedR in 1.5%. BMI: 44.3 (42-47.8) Conversion: 4.5% (0-23.6). Complications, mean(range): Gastric perforation: 1% (0-4) - Bleeding: 0.8% (0-4) - Other intraop. complications: 0.5% (0-1.3) - Medical postop. complic. 0.6-23% - Mortality: 0.4% (0-3.3). Cumulative abdominal reoperation rate: 10.5% (Revision: 5.3% - Reversal: 2.5% - Other: 1.4% - Gastric incorporation of band: 1.3%). Port/catheter: 3.8% (0-10.4). Follow-up time1weight loss (n= publications reporting): Mean F/U period: 23 months (6). Per cent of patients followed: >90% (6). Mean excess weight loss at 24 months: 61% (7), 36 m.: 56.7% (4), >36 months: 50.3% (1). Only 10, 6 and 1 publications reported weight loss at 24, 36 and >36 months, respectively. The results are very similar to the 1 st. review. Conclusions: The number of operations has increased, as well as the rate of publications. Obesity Surgery continues to be the premier source of information. The quality of the publications has improved, although only 3/23 had the information readily available and well organized. Several articles showed data contradictions in between the abstract and the text. The mean BIVII is lower than most American series. The majority of the papers selected have <200 patients and very short follow-up. Complication, reoperation, port/catheter problem and mortality rates have not changed overtime. Although the new adjustable devices have been used for >1 0 years, long-term follow-up, analysis of late complications and weight loss reporting continues to be unsatisfactory. The newly published data is again insufficient to judge the merits of the procedure. In view of the results of this updated review, bariatric surgeons need to moderate their enthusiasm, study the information available and conduct proper scientific trials to objectively evaluate the outcomes of this novel technique. |
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