John O’dea, BE MED PhD, Robert G Snow, DO FACOS. NUI Galway, Ireland; Specialty Surgery Center of Fort Worth, TX
Objective
We have previously demonstrated that intra-operative adjustment of a gastric band to a stoma size of 6.5mm appears to confer an advantage of approximately 5%EWL in the period 4-6 weeks after surgery [1], such adjustment being well tolerated by patients. We sought to assess how adjusting the band more tightly, setting the stoma size to 5.5mm during surgery, would be tolerated, and whether it would improve early post-operative weight loss.
Methods
The EndoFLIP™ system (Crospon, Galway, Ireland) and BF-325 balloon catheter were used to intra-operatively set the stoma size in the APS (Small,S) and APL (Large,L) Model Lap-Bands® (Allergan Inc., Irvine, CA) in 50 consecutive patients, and %EWL was measured at the first follow-up visit in the period 4-6 weeks after surgery. %EWL was compared a) against a group of historic control patients who did not have intra-operative band adjustment and (b) a group of patients who previously had intra-operative band adjustment to a stoma size of 6.5mm.
Results
The following were the demographics and %EWL results for the three groups (mean(SD)) :
| Group | N | Age(y) | Weight (lb) | BMI | Sex(F:M) | %EWL | Δ%EWL* | P |
|---|---|---|---|---|---|---|---|---|
| 6.5mm | 23 | 45.8(10.8) | 266(57) | 41.7(8.1) | 20:3 | 20.8(10.8) | ||
| 5.5mm | 50 | 47.0(10.5) | 256(52) | 41.8(7.0) | 44:6 | 14.6(9.6) | -6.1 | 0.03 |
| No Adjust | 39 | 41.8(12.2) | 283(62) | 45.0(8.0) | 28:11 | 15.6(8.9) | -5.2 | 0.11 |
*Compared with 6.5mm group
Patients tolerated the 5.5mm intra-operative adjustment comfortably. The difference in %EWL between the 5.5mm adjusted group and the historic controls was not significant (Δ%EWL = 0.97, p=0.88).
Conclusions: Tightening the band to 5.5mm did not improve %EWL in the 4-6 week post-operative period versus historic controls. This supports previous observations [2] that a stoma size reduction of 1mm could potentially move a patient from the green zone (6.5mm stoma size) to the red zone (5.5mm stoma size), potentially leading to maladaptive eating behavior.
References:
1. Snow RG, O’Dea J Intra-operative Band Stoma Adjustment Improves Early Post-Operative Weight Loss. Obesity Surgery Vol. 20 No. 8 969-1077, July 2010
2. Snow RG, O’Dea J Is there an optimal gastric band stoma size. Surgical Endoscopy Vol. 24 Supp. 1, S318, Apr 2010
Session Number: Poster – Poster Presentations
Program Number: P441
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