TY - JOUR
T1 - Evaluating gastric erosion in band management
T2 - An algorithm for stratification of risk
AU - Kurian, Marina
AU - Sultan, Sammy
AU - Garg, Karan
AU - Youn, Heekoun
AU - Fielding, George
AU - Ren-Fielding, Christine
PY - 2010
Y1 - 2010
N2 - Background: Laparoscopic gastric banding has several known complications, including gastric erosion. No clear factors have been determined for the development of band erosion, but technical factors such as covering the buckle of the band have been implicated. The objective of the present study was to determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States. Methods: We performed a retrospective review of a prospective institutional review board-approved database. All patients who had been followed from 2002 to 2008 were identified. The maximal band volume was 4 cm3 for the 9.75-cm/10-cm band and 10 cm3 for the Vanguard band. The bands were considered overfilled if they had been filled to greater than the maximal volume for ≥3 months. Results: A total of 2437 patients had undergone Lap-Band surgery. Of these 2437 patients, 14 developed erosion (.57%). The primary erosion rate was .39% (9 of 2359). These patients were divided into 3 groups according to the type of band placed: group 1, Vanguard (n = 735); group 2, 9.75-cm/10-cm band (n = 1624); and group 3, revisions to Vanguard, including a band placed around a bypass (n = 78). The incidence of gastric erosion by group was .95% (7 of 735) in group 1, .12% (2 of 1624) in group 2, and 6.41% (5 of 78) in group 3. The difference in the erosion rate among the groups was significant (group 1 versus 2, P = .005; group 3 versus 1, P = .003; and group 3 versus 2, P = .001). Erosions developed in each group without overfilling. Also, comparing the erosion rate in the overfilled versus underfilled bands, statistical significance was found only for group 1 at 3.18% versus .35% (P = .006). The erosion rate in the overfilled versus underfilled was 1.01% versus .07% in group 2 and 11.11% versus 3.92% in group 3. Conclusion: A band that needs to be overfilled might be a sign of erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm3 bands.
AB - Background: Laparoscopic gastric banding has several known complications, including gastric erosion. No clear factors have been determined for the development of band erosion, but technical factors such as covering the buckle of the band have been implicated. The objective of the present study was to determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States. Methods: We performed a retrospective review of a prospective institutional review board-approved database. All patients who had been followed from 2002 to 2008 were identified. The maximal band volume was 4 cm3 for the 9.75-cm/10-cm band and 10 cm3 for the Vanguard band. The bands were considered overfilled if they had been filled to greater than the maximal volume for ≥3 months. Results: A total of 2437 patients had undergone Lap-Band surgery. Of these 2437 patients, 14 developed erosion (.57%). The primary erosion rate was .39% (9 of 2359). These patients were divided into 3 groups according to the type of band placed: group 1, Vanguard (n = 735); group 2, 9.75-cm/10-cm band (n = 1624); and group 3, revisions to Vanguard, including a band placed around a bypass (n = 78). The incidence of gastric erosion by group was .95% (7 of 735) in group 1, .12% (2 of 1624) in group 2, and 6.41% (5 of 78) in group 3. The difference in the erosion rate among the groups was significant (group 1 versus 2, P = .005; group 3 versus 1, P = .003; and group 3 versus 2, P = .001). Erosions developed in each group without overfilling. Also, comparing the erosion rate in the overfilled versus underfilled bands, statistical significance was found only for group 1 at 3.18% versus .35% (P = .006). The erosion rate in the overfilled versus underfilled was 1.01% versus .07% in group 2 and 11.11% versus 3.92% in group 3. Conclusion: A band that needs to be overfilled might be a sign of erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm3 bands.
KW - Gastric erosion
KW - Laparoscopic gastric banding
KW - Vanguard band
UR - http://www.scopus.com/inward/record.url?scp=78149232207&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78149232207&partnerID=8YFLogxK
U2 - 10.1016/j.soard.2009.11.020
DO - 10.1016/j.soard.2009.11.020
M3 - Article
C2 - 20176510
AN - SCOPUS:78149232207
SN - 1550-7289
VL - 6
SP - 386
EP - 389
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 4
ER -