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June Warman - One of the best experts on this subject based on the ideXlab platform.
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Thrombosis of the Lap-Band system
Surgical Endoscopy, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Alan C Geiss, Melanie Howard, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage. Methods We report a case of a patient suspected of having a Lap-Band leak. He presented with a clinical course of multiple adjustments without restriction and inability to aspirate the expected volume from the band. Following adjustment under fluoroscopy he became severely dysphagic. He underwent urgent operative exploration and was found to have an intact but overinflated band. Under close inspection, a clot in the proximal band was noted, acting as a ball valve allowing the addition of fluid but not aspiration. Conclusions This case highlights an unusual explanation for what is thought of as typical signs of band leakage. In addition it raises serious questions about the importance of preventing blood and particulate matter from entering the Lap-Band system both at the initial operation and at subsequent adjustments.
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Thrombosis of the Lap-Band system.
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage.
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posterior Prolapse an important entity even in the modern age of the pars flaccida approach to lap band placement
Obesity Surgery, 2006Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable Gastric band (LAGB) surgery are pouch dilatation and Gastric Prolapse (slippage). Gastric Prolapse can be divided into the anterior and posterior variety. Posterior Prolapse is thought to be specific to the periGastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior Prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior Prolapse requiring reoperation. Results: All 3 patients presented with similar complaints, including solid food intolerance, gastro-esophageal reflux and/or regurgitation. Although identical to those reported with anterior Prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. Conclusion: The finding of 3 patients who experienced posterior Prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.
Danny A Sherwinter - One of the best experts on this subject based on the ideXlab platform.
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Experimental in vivo canine model for Gastric Prolapse of laparoscopic adjustable Gastric band system.
Surgery for Obesity and Related Diseases, 2009Co-Authors: Danny A Sherwinter, Amar Gupta, Lee S. Cummings, Sidney Z. Brejt, Jerzy Macura, Harry AdlerAbstract:Abstract Background The most prevalent long-term complications in patients undergoing laparoscopic adjustable Gastric band (LAGB) surgery are symmetric pouch dilation and Gastric Prolapse (slippage). However, no published data or a reliable model are available to evaluate the actual mechanism of band slippage or how to prevent it. The objective of the present study was to construct an animal model of anterior Gastric band Prolapse and to use this model to evaluate the effectiveness of various arrangements of gastroGastric sutures and Gastric wraps in preventing Prolapse. Methods The esophagus of male mongrel dogs was accessed through the left chest, and a pressure transducer and an insufflation catheter were introduced. An AP-S Lap-Band (Allergan, Irvine, CA) filled to 10 cm 3 was placed using the pars flaccida technique. A standardized cut of meat was placed into the esophagus to simulate food impaction at a tight LAGB. After the placement of multiple different gastroGastric suture configurations, air was insufflated into the Gastric pouch by way of the esophagus. Results Prolapse, identical to that seen in clinical practice, was reliably reproduced in this model by increased esophageal pressure acting on a LAGB outlet obstruction. In addition, Prolapse was reproduced with all gastroGastric configurations that did not secure the anterior Gastric wall to within 1.5 cm of the lesser curve. Conclusion The results of the present study support the theory that Prolapse is caused by esophageal peristalsis against an occlusion at the level of the LAGB. In this canine model, gastroGastric sutures encompassing the anterior Gastric wall were integral to preventing Prolapse.
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Thrombosis of the Lap-Band system
Surgical Endoscopy, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Alan C Geiss, Melanie Howard, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage. Methods We report a case of a patient suspected of having a Lap-Band leak. He presented with a clinical course of multiple adjustments without restriction and inability to aspirate the expected volume from the band. Following adjustment under fluoroscopy he became severely dysphagic. He underwent urgent operative exploration and was found to have an intact but overinflated band. Under close inspection, a clot in the proximal band was noted, acting as a ball valve allowing the addition of fluid but not aspiration. Conclusions This case highlights an unusual explanation for what is thought of as typical signs of band leakage. In addition it raises serious questions about the importance of preventing blood and particulate matter from entering the Lap-Band system both at the initial operation and at subsequent adjustments.
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Thrombosis of the Lap-Band system.
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage.
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posterior Prolapse an important entity even in the modern age of the pars flaccida approach to lap band placement
Obesity Surgery, 2006Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable Gastric band (LAGB) surgery are pouch dilatation and Gastric Prolapse (slippage). Gastric Prolapse can be divided into the anterior and posterior variety. Posterior Prolapse is thought to be specific to the periGastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior Prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior Prolapse requiring reoperation. Results: All 3 patients presented with similar complaints, including solid food intolerance, gastro-esophageal reflux and/or regurgitation. Although identical to those reported with anterior Prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. Conclusion: The finding of 3 patients who experienced posterior Prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.
Christine J. Ren - One of the best experts on this subject based on the ideXlab platform.
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US experience with the LAP-BAND system
2015Co-Authors: Christine J. Ren, Santiago Horgan, Jaime PonceAbstract:Laparoscopic adjustable Gastric banding is the most commonly performed operation for morbid obesity in Europe and Australia and has been shown to result in significant long-term weight loss. The US Food and Drug Administration (FDA)–monitored clinical trial results with the LAP-BAND system (INAMED Health, Santa Barbara, CA) did not reproduce the results of studies performed elsewhere in the world. This article reviews data from the first and second FDA clinical trials as well as data from continuing US clinical experience. Four American surgeons at 4 centers have performed more than 500 LAP-BAND procedures not included in the first 2 FDA clinical trials. Of these patients, 115 have been followed for at least 9 months, and 43 have been followed for at least 12 months. A retrospective analysis of prospective data gathered from these patients is presented. The percent excess weight loss was 35.6 % at 9 months and 41.6 % at 12 months. The average body mass index decreased from 47.5 to 38.8 in 9 months and from 47.5 to 37.3 in 12 months. There were no deaths related to the insertion of the device. Of 15 complications requiring operative management (13%) in 12 patients, there were 8 port displacements or tubing breaks (7%), 2 elective explantations (2%), 2 cases of Gastric Prolapse (2%), 1 Gastric pouch dilatation (1%), 1 port abscess (1%), and 1 hemorrhage (1%). Clinical experience with the LAP-BAND system in the United States shows the device to be a safe and effective treatment for morbid obesity, with results comparable to the international data. The combination of proper surgical technique and close patient follow-up with frequent band adjustments, performed in a comprehensive bariatric program setting, may make the LAP-BAND system a powerful surgical tool in the treatment of morbid obesity. © 2002 Excerpta Medica Inc. All rights reserved. Laparoscopic adjustable Gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA) has proved to be safe and effective in Europe and Australia
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Hiatal hernia repair at the initial laparoscopic adjustable Gastric band operation reduces the need for reoperation
Surgical Endoscopy, 2008Co-Authors: Iosif Gulkarov, Christine J. Ren, Meredith Wetterau, George A. FieldingAbstract:Background Intractable reflux, either due to Gastric Prolapse or concentric pouch dilatation has been the most common indication for reoperation or band removal after laparoscopic adjustable Gastric banding (LAGB). We have previously found that a simple hiatal hernia repair (HHR) leads to remission of these symptoms minimizing the need for band removal. We have subsequently added crural repair/HHR at the initial operation, where indicated. In this study compare the rate of reoperation in patients who underwent LAGB alone, or with concurrent HHR. Methods A retrospective review of a prospective database of all patients undergoing LAGB was performed to determine the incidence of reoperation in the two groups. Results Between July 2001 and August of 2006, 1298 patients underwent LAGB and 520 patients underwent LAGB with concurrent HHR (LAGB/HHR). The mean initial weight and BMI were 128 kg (range, 71.1–245.7 kg) and 45.4 kg/m^2 (range, 28–75 kg/m^2). Average follow-up for the LAGB and LAGB/HHR groups was 24.8 and 20.5 months, respectively. Rate of reoperation for HHR alone, or with band slip or concentric pouch dilatation, for LAGB and LAGB/HHR groups was 5.6% and 1.7% respectively ( p
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Hiatal hernia repair at the initial laparoscopic adjustable Gastric band operation reduces the need for reoperation
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Iosif Gulkarov, Christine J. Ren, Meredith Wetterau, George FieldingAbstract:Background Intractable reflux, either due to Gastric Prolapse or concentric pouch dilatation has been the most common indication for reoperation or band removal after laparoscopic adjustable Gastric banding (LAGB). We have previously found that a simple hiatal hernia repair (HHR) leads to remission of these symptoms minimizing the need for band removal. We have subsequently added crural repair/HHR at the initial operation, where indicated. In this study compare the rate of reoperation in patients who underwent LAGB alone, or with concurrent HHR.
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U.S. experience with 749 laparoscopic adjustable Gastric bands: intermediate outcomes.
Surgical Endoscopy and Other Interventional Techniques, 2005Co-Authors: Manish Parikh, George Fielding, Christine J. RenAbstract:Laparoscopic adjustable Gastric band (LAGB) has consistently been shown to be a safe and effective treatment for morbid obesity, especially in Europe and Australia. Data from the U.S. regarding the LAGB has been insufficient. This study reveals our experience with 749 primary LAGB over a 3-year period in a U.S. university teaching hospital. All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study include preoperative age, BMI, gender, race, conversion rate, operative time, hospital stay, percent excess weight loss (%EWL) and postoperative complications. Annual esophagrams were performed From July 2001 through September 2004, 749 patients (531 females, 218 males) underwent LAGB for the treatment of morbid obesity. There were 630 Caucasians, 61 African-Americans, and 49 Latin Americans, with a mean age of 42.3 (range 18, 72 years) and mean BMI of 46.0 ± 7.0 (range 35, 91.5 kg/m2). There was one conversion to open (0.1%). Median operative time and hospital stay were 60 minutes and 23 hours, respectively. The mean %EWL at 1 year, 2 years, and 3 years was 44.4 (±17.8), 51.8 (±20.9), and 52.0 (±19.6), respectively. There were no mortalities. Postoperative complications occurred in 12.8% of patients: 1.5% acute postoperative band obstruction, 0.9% wound infection, 2.9% Gastric Prolapse (“slip”), 2.0% concentric pouch dilatation (without slip), 0.8% aspiration pneumonia, 2.4% port/tubing problems, 0.3% severe esophageal dilatation/dysmotility (reversible), and 1.5% overall band removal. These American results substantiate the data from abroad that LAGB is a safe and effective treatment for morbid obesity.
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Laparoscopic Adjustable Gastric Banding: Surgical Technique
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2003Co-Authors: Christine J. Ren, George FieldingAbstract:Laparoscopic adjustable Gastric banding is an effective and safe surgical treatment for morbid obesity. Initial experience with the Lap-Band™ system (Inamed Health, Santa Barbara, California) in the United States and Australia has demonstrated that surgical technique can affect outcomes in terms of weight loss, quality of life, and complication rates. Placement of the Gastric band by means of the periGastric technique is associated with high rates of Gastric Prolapse, food intolerance, and weight loss failure that frequently lead to band explantation. In the pars flaccida technique, band placement higher on the stomach results in the formation of a smaller pouch and lower rates of Gastric Prolapse, which may contribute to greater weight loss and improved quality of life. This article describes the technical aspects of the pars flaccida approach in the laparoscopic placement of adjustable Gastric bands.
Colin J Powers - One of the best experts on this subject based on the ideXlab platform.
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Thrombosis of the Lap-Band system
Surgical Endoscopy, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Alan C Geiss, Melanie Howard, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage. Methods We report a case of a patient suspected of having a Lap-Band leak. He presented with a clinical course of multiple adjustments without restriction and inability to aspirate the expected volume from the band. Following adjustment under fluoroscopy he became severely dysphagic. He underwent urgent operative exploration and was found to have an intact but overinflated band. Under close inspection, a clot in the proximal band was noted, acting as a ball valve allowing the addition of fluid but not aspiration. Conclusions This case highlights an unusual explanation for what is thought of as typical signs of band leakage. In addition it raises serious questions about the importance of preventing blood and particulate matter from entering the Lap-Band system both at the initial operation and at subsequent adjustments.
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Thrombosis of the Lap-Band system.
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage.
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posterior Prolapse an important entity even in the modern age of the pars flaccida approach to lap band placement
Obesity Surgery, 2006Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable Gastric band (LAGB) surgery are pouch dilatation and Gastric Prolapse (slippage). Gastric Prolapse can be divided into the anterior and posterior variety. Posterior Prolapse is thought to be specific to the periGastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior Prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior Prolapse requiring reoperation. Results: All 3 patients presented with similar complaints, including solid food intolerance, gastro-esophageal reflux and/or regurgitation. Although identical to those reported with anterior Prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. Conclusion: The finding of 3 patients who experienced posterior Prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.
Alan C Geiss - One of the best experts on this subject based on the ideXlab platform.
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Thrombosis of the Lap-Band system
Surgical Endoscopy, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Alan C Geiss, Melanie Howard, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage. Methods We report a case of a patient suspected of having a Lap-Band leak. He presented with a clinical course of multiple adjustments without restriction and inability to aspirate the expected volume from the band. Following adjustment under fluoroscopy he became severely dysphagic. He underwent urgent operative exploration and was found to have an intact but overinflated band. Under close inspection, a clot in the proximal band was noted, acting as a ball valve allowing the addition of fluid but not aspiration. Conclusions This case highlights an unusual explanation for what is thought of as typical signs of band leakage. In addition it raises serious questions about the importance of preventing blood and particulate matter from entering the Lap-Band system both at the initial operation and at subsequent adjustments.
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Thrombosis of the Lap-Band system.
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background The laparoscopic adjustable Gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include Gastric Prolapse, band erosion, hardware infection, and port/tubing leakage.
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posterior Prolapse an important entity even in the modern age of the pars flaccida approach to lap band placement
Obesity Surgery, 2006Co-Authors: Danny A Sherwinter, Colin J Powers, Melanie L Howard, Alan C Geiss, June WarmanAbstract:Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable Gastric band (LAGB) surgery are pouch dilatation and Gastric Prolapse (slippage). Gastric Prolapse can be divided into the anterior and posterior variety. Posterior Prolapse is thought to be specific to the periGastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior Prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior Prolapse requiring reoperation. Results: All 3 patients presented with similar complaints, including solid food intolerance, gastro-esophageal reflux and/or regurgitation. Although identical to those reported with anterior Prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. Conclusion: The finding of 3 patients who experienced posterior Prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.