Page 29 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):30-34
Emmanuel E Akpo
Laparoscopic Adjustable Silicon

Gastric Banding versus Sleeve

Gastrectomy

Emmanuel E Akpo
Consultant Laparoscopic Surgeon, Surgery Department, Delta State University, Abraka, Delta State, Nigeria

Abstract acceptability and the physicians’ dilemma. Laparoscopic
Background and purpose: Obesity now forms one of the leading adjustable silicone gastric banding (LASGB) and laparoscopic
public health concerns globally. Several surgical options including sleeve sleeve gastrectomy are emerging surgical procedures for the
gastrectomy exist for its treatment. Recently, laparoscopic gastric treatment of morbid obesity. Their main advantage is
banding has been developed with the aim of providing a laparoscopically comparable reduction in complication rates. 12,13 Laparoscopic
placed device that is safe and effective in generating substantial weight adjustable gastric banding (LAGB) was introduced in the early
loss. The goal of this review is to compare the effectiveness and safety
of laparoscopic adjustable silicon gastric banding (LASGB) and 1990s to serve as a minimally invasive, potentially safe, reversible
laparoscopic sleeve gastrectomy (LSG) in the treatment of morbid and controllable method to achieve significant weight loss by
obesity by reviewing the methods of patient selection, operative time, using a gastric band incorporating an adjustable silicone balloon
conversion rate, complications, blood loss, postoperative morbidity for open placement.
and mortality, hospital stay, and quality of life. Laparoscopic sleeve gastrectomy (LSG) was introduced as
Material and methods: A systematic literature search was performed a multipurpose restrictive procedure for obese patients. 14-17 It
using Highwire press, Springer link, Medline, Medscape and Google, is now becoming more common as a single-stage operation for
and article bibliographies to identify relevant evidence. Included studies the treatment of morbid obesity. It however appears that the
must have reported outcome data for more than 40 patients aged 20 volume of gastric tissue excised greatly affects weight loss.
years and above with a minimum of one 1-year follow-up. The operating Hence it is said that a removed gastric volume of < 500 cc might
time, complications, blood loss, hospital stay, morbidity and mortality, be a predictor of failure in treatment or early weight regain,
and quality of life were reviewed. though a safe and effective restrictive bariatric procedure. 16,17
Results: The total number of patients enrolled was 4,519; the specific Both LASGB and LSG have their drawbacks and the current
procedure totals were 3,714 for LAGB and 805 for LSG. The age literature is scarce concerning which approach is superior. The
range of the population studied was 13-79 years for LSG and 18-65 goal of this review is to compare the effectiveness and safety of
years for LAGB. The sex distribution had a male:female ratio of 1:4 LASGB and LSG in the treatment of morbid obesity by reviewing
for LAGB and 1:3 for LSG. The overall complication rate in this the methods of patient selection, operative time, conversion
review varied from 1.7-11. 80% for LSG and 0.2-24% for LAGB.
rate, complications, blood loss, postoperative morbidity and
Conclusion: Laparoscopic sleeve gastrectomy though, forms a safe mortality, hospital stay, and quality of life.
surgical option for weight loss treatment particularly in the very-
2
very-obese patients (BMI > 60 kg/m ). LASGB gives satisfactory
results and coupled with reversibility and low cost, it is an important MATERIAL AND METHODS
tool in the long-term management of patients with morbid obesity. A systematic literature search of articles published between
Keywords: Laparoscopic adjustable silicon gastric banding, January 1, 2000 and March 24, 2009 was performed using
laparoscopic sleeve gastrectomy, bariatric surgery. Highwire press, Springerlink, Medline and Google. Further
articles were identified from the reference lists of retrieved
INTRODUCTION literature. A meta-analysis was impossible because of
inconsistencies in the various reports. A simple percentage
The health and economic impact of obesity remain a global was therefore used as recorded in the various articles.
dilemma. 1-10 This has resulted in excallating research modalities
to combate the disease. It has been shown that surgery provides ARTICLE INCLUSION CRITERIA
a long-term solution to the problem of obesity by reducing
mortality by 31.6% compared with nonoperative methods. 11 All patients must have been age more than 20 years at the time
The advent of minimal access surgery has revolutionized patient of surgery. The study must have appeared in a peer-reviewed

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