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Band slippage and erosion after laparoscopic gastric banding: a meta-analysis.

Singhal, Rishi and Bryant, Catherine and Kitchen, Mark and Khan, Khalid S and Deeks, Jon and Guo, Boliang and Super, Paul (2010) Band slippage and erosion after laparoscopic gastric banding: a meta-analysis. Surgical endoscopy, 24 (12). pp. 2980-6. ISSN 1432-2218. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://link.springer.com/article/10.1007%2Fs00464-...

Abstract

BACKGROUND

Laparoscopic adjustable gastric banding has the lowest morbidity and mortality rates among the common bariatric procedures. Troublesome complications associated with this procedure include band slippage and erosion, often requiring revisionary surgery. Rates of slippage have decreased, and this appears to be due to changes in surgical technique. In the authors' experience, units with a low slippage rate also have a low erosion rate and vice versa. Thus a systematic review was undertaken to investigate this relationship.

METHODS

Electronic databases were searched up to 31 December 2008. Publications focusing solely on laparoscopic adjustable gastric banding with at least 500 patients and a minimum follow-up period of 2 years were included in the study. Publications in languages other than English and those that failed to mention erosion and slippage rates were excluded. Multivariate meta-analyses were conducted separately for the pars flaccida group, the perigastric group, and the combined overall group to pool the average rates of both erosion and slippage for each paper included. The correlation between the occurrence rates for both erosion and slippage then was examined.

RESULTS

The inclusion criteria were met by 19 studies. The mean rates of erosion and slippage were 1.03 and 4.93, respectively. The results demonstrated a statistically significant overall correlation between erosion and slippage rates (r = 0.48, p = 0.032). A very strong correlation between erosion and slippage was found if the perigastric technique of insertion was used (r = 0.99, p < 0.001). However, this correlation was not statistically significant where the pars flaccida technique of insertion was used (r = 0.34, p = 0.38).

CONCLUSIONS

The high correlation rate between erosion and slippage for the perigastric group strongly suggests that these complications share a common pathophysiology. This correlation is reduced with the pars flaccida technique, suggesting that perhaps a different etiology is associated with erosion in these studies. Surgical techniques that help to eliminate lap band slippage should also reduce rates of erosion.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WI Digestive system. Gastroenterology
WO Surgery
Divisions: Planned IP Care > Gastroentrology
Planned IP Care > General Surgery
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 12 Jun 2014 15:23
Last Modified: 12 Jun 2014 15:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/247

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