Document Detail


Surgeon-performed fluoroscopy conducted simultaneously during all laparoscopic adjustable gastric band adjustments results in significant alterations in clinical decisions.
MedLine Citation:
PMID:  19763706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little data exists regarding filling regimens for laparoscopic adjustable gastric bands (LAGB). In addition to patient symptoms and weight changes, we have instituted surgeon-performed, real-time fluoroscopic evaluation in our clinical decision making during all band adjustments. OBJECTIVE: Our hypothesis is that surgeon-performed, real-time contrast fluoroscopy conducted routinely during all LAGB adjustment results in significant deviations in clinical care. SETTING: The study is set at the Academic Referral Center, United States METHODS: Fifty-two consecutive patients who underwent LAGB and presented for adjustment were given a questionnaire evaluating obstructive symptoms. The patient's weight loss history was also reviewed. Each patient underwent real-time fluoroscopy performed by the surgeon during adjustment. Data were recorded and compared to final decision to fill, make no adjustment, or remove fluid. RESULTS: Patients were, on average, at post-operative visit 5. Sixty-three percent of patients received a fill, 31% had no change, and 6% had fluid removed. On the questionnaire, 15% of patients noted reflux, 10% had dysphagia, and 8% had regurgitation. Eighty percent of patients requested a fill. Thirty-one percent had an abnormality noted on fluoroscopy. Fifteen percent of patients demonstrated esophageal dilation, 15% had a delay of greater than 5 s, 19% had reflux of contrast. Three patients had band displacements on imaging. Additionally, six patients (12%) were not filled based on fluoroscopic findings alone, not predicted by either the survey or historical weight loss. CONCLUSION: Surgeon-performed, real-time, fluoroscopy during LAGB adjustment results in significant changes in clinical care that are not predicted by history and weight loss alone. Routine fluoroscopic imaging altered the course of management in 12% of patients and identified three asymptomatic displaced bands.
Authors:
Matthew Kroh; Stacy Brethauer; Nancy Duelley; Tomasz Rogula; Philip Schauer; Bipan Chand
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Publication Detail:
Type:  Journal Article     Date:  2009-09-18
Journal Detail:
Title:  Obesity surgery     Volume:  20     ISSN:  1708-0428     ISO Abbreviation:  Obes Surg     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9106714     Medline TA:  Obes Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  188-92     Citation Subset:  IM    
Affiliation:
Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, OH, USA. krohm@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Body Mass Index
Decision Making
Esophageal Diseases / epidemiology
Female
Fluoroscopy
Gastroesophageal Reflux / epidemiology
Gastroplasty / adverse effects*,  instrumentation*,  methods
Humans
Laparoscopy
Male
Middle Aged
Obesity, Morbid / surgery*
Postoperative Complications / epidemiology
Questionnaires
Treatment Outcome
Weight Loss

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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