Biomedical subjects

Laurent Biertho

Publications and source records attributed to Laurent Biertho.

6 recordsLinked to original sources

PubMed2005

Management of failed adjustable gastric banding.

BACKGROUND: About 100,000 adjustable gastric band placements have been performed worldwide, but more than 10% of patients have needed reoperation for insufficient weight loss or device-related complications. This study investigates the complications following gastric banding, and the outcome using a structured management strategy. METHODS: In the period April 1996 to January 2002, 824 severely obese patients (body mass index 43 +/- 1 kg/m 2 [mean +/- standard error under the mean], age 43 +/- 1 years; 77% women) underwent gastric banding in a single institution and were followed prospectively. Complications, insufficient weight loss, and subsequent management were analyzed. RESULTS: By the fifth treatment year, excess weight loss (EWL) was 54.8 +/- 1.7%; 72.8% of patients lost weight continuously or attained EWL of at least 50%. Insufficient weight loss occurred in 143 patients, and band-related complications occurred in 131 patients, with a mean annual rate of 5.0%. Major reoperation was necessary in 121 patients, and the annual reoperation rate was 4.7%. Following major reoperation, band- and bypass-related complication rates ranged from 6.3% to 11.7% per year. Three deaths occurred, 1 after reoperation and 2 due to preexisting cardiovascular disease. CONCLUSIONS: Applying a structured reoperation algorithm, 5% annual failure after banding was corrected in most patients, and 72.8% of patients attained sufficient weight loss. Reoperation-related mortality was low (.8%), and its annual morbidity was acceptable (4.6%).

Adolescent↗

PubMed2003

Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases.

BACKGROUND: Indications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques. STUDY DESIGN: We compared a series of 456 LGB to a series of 805 LAGB performed in two different institutions. Body mass index (BMI), complication rate, mortality, and excess weight loss (EWL) after 3, 6, 12, and 18 months were obtained. A Fischer's exact test and a Student t test with covariance analysis were used for statistical analysis. RESULTS: Results are expressed as a mean +/- standard deviation, comparing LGB with LAGB. Preoperative BMI was 49.4 +/- 8.3 kg/m(2) versus 42.2 +/- 4.9 kg/m(2) (p = 0.0001), respectively. Perioperative major complication rates were 2.0% versus 1.3% (NS), and the early postoperative major complication rates were 4.2% versus 1.7% (p = 0.02), respectively. Mortality rate was 0.4% versus 0% (NS), respectively. The global EWL was 36.3% for LGB versus 14.7% for LAGB at 3 months (p < 0.0001), 51.6% versus 21.9% at 6 months (p < 0.0001), 67.0% versus 33.3% at 12 months (p < 0.0001), and 74.6% versus 40.4% at 18 months (p < 0.0001), respectively. Longterm followup for the LAGB group showed an EWL of 47% at 2 years, 56% at 3 years, and 58% at 4 years. Patients were sorted after their preoperative BMI (30 to 40, 40 to 50, and 50 to 60 kg/m(2)). The EWL at 3, 6, 12, and 18 months was statistically superior in the LGB group, for any BMI ranges. CONCLUSIONS: These data suggest that LGB provides a higher EWL at 18 months, compared with LAGB, and this was true for any preoperative BMI range. It is associated with a higher early postoperative complication rate.

Adolescent↗

PubMed2003

Taking posterior rectus sheath laparoscopically to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: The Roux-en-Y gastric bypass (RYGBP) is now performed laparoscopically widely with low morbidity and mortality. However, in some cases long-term adequate weight loss is not satisfied because of dilatation of the gastrojejunostomy. Therefore, a prosthetic material and bio-membranes have been used to prevent dilatation. In this study, we used posterior rectus sheath by laparoscopy, to evaluate feasibility and safety of the procedure. METHODS: 20 Yorkshire pigs, under general anesthesia, had a standard laparoscopic RYGBP. In addition, 10 had their gastrojejunostomy anastomosis wrapped with 2x10 cm posterior rectus sheath. Clinical and operative outcome after operation were compared with the control group of laparoscopic RYGBP cases. RESULTS: The median weight of the pigs was 46.1 kg (range 42-51) in the posterior rectus sheath-applied group and 45.2 kg (range 42-49) in the control group. All gastrojejunostomies in the posterior rectus sheath-applied group were successfully reinforced laparoscopically. Both groups loss weight compared with their normal growth weight, but there was no significant difference in the median weight loss between the two groups. Two pigs in the posterior rectus sheath-applied group developed a stenosis at the gastrojejunostomy anastomosis following RYGBP. All pigs in the posterior rectus sheath-applied group were found to develop hypertrophic smooth muscle and connective tissue scarring at the gastrojejunostomy on histologic examination. CONCLUSION: Laparoscopic application of posterior rectus sheath around the gastrojejunostomy in laparoscopic RYGBP is feasible and safe. The sheath-applied group developed stenosis and connective tissue scarring. Additional research is needed to evaluate effectiveness in preventing dilation of the anastomosis.

Abdominal Muscles↗

PubMed2003

Laparoscopic Swedish adjustable gastric banding: a five-year prospective study.

BACKGROUND: Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. However, the long-term complication rate and weight loss are still unclear. METHODS: 824 patients underwent a laparoscopic Swedish Adjustable Gastric Banding (SAGB) in a 5-year period. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained for analysis. RESULTS: Mean age of the 824 patients was 43 +/- 1 years, with mean preoperative BMI 43 +/- 1 kg/m(2). No intra- or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 5.2%. Peri-operative complication rate was 1.2%. 97% of the patients were available for follow-up (maximum 5 years). Long-term complications occurred in 191 patients (23.2%). 135 complications (16.4%) were related to the band, and 56 (6.8%) to the access-port or to the tube. Mean excess weight loss was 30, 41, 49, 55 and 57 % after 1, 2, 3, 4 and 5 years respectively. 82.9% of the patients obtained >50% EWL after initial treatment. CONCLUSIONS: The results of this study suggest that laparoscopic SAGB can achieve an effective weight loss, with an acceptable mortality and morbidity rate.

Adult↗

PubMed2003

Laparoscopic adjustable gastric banding with duodenal switch for morbid obesity: technique and preliminary results.

BACKGROUND: The procedure of choice for morbid obesity remains controversial. One of the most effective treatments is the biliopancreatic diversion with duodenal switch (BPD/DS), which is, however, associated with a significant morbidity rate. Adjustable gastric banding (AGB) by the laparoscopic approach is an easier procedure with the intent to reduce complication rates. It replaced the sleeve gastrectomy in this study. The objective was to assess the feasibility and safety of this new laparoscopic treatment. METHODS: AGB with duodenal switch (DS) was performed laparoscopically with 7 trocars. A gastric band was appropriately placed below the gastroesophageal junction, followed by BPD/DS with a 250-cm alimentary channel and a 100-cm common channel. RESULTS: All 5 patients were women, with mean preoperative BMI 52.2 kg/m(2) (40.6 to 64.4). The operations were performed via laparoscopy in a mean of 206 +/- 35 minutes. There was no postoperative complication, infection or conversion. Mean hospital stay was 8.8 days (8-11). At 12 months, mean BMI is 35.8 kg/m(2) (26.1-46.0), with continuing weight loss and no hypoalbuminemia. CONCLUSIONS: These data suggest that laparoscopic AGB/DS is feasible, with a low morbidity rate. This technique could combine the long-term weight loss of malabsorptive procedures, with a low-morbidity, adjustable, restrictive procedure. This technique could be used in selected patients, but requires a larger study with longer follow-up.

Adult↗

PubMedDate not supplied

Comparison between open hand-sewn, laparoscopic stapled and laparoscopic computer-mediated, circular stapled gastro-jejunostomies in Roux-en-Y gastric bypass in the porcine model.

BACKGROUND: In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis. METHODS: RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured. RESULTS: 14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis. CONCLUSION: We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.

Anastomosis, Surgical↗