Laparoscopic adjustable gastric banding: The 'learning curve' period

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 patient's selection/follow-up carried out by a multidisciplinar staff and the 'learning curve' 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 'learning curve' period (1-30 patients). The multidisciplinary selection allowed an earlier detection of the band-related complications and to improve patients compliance.