Laparoscopic adjustable gastric banding (LAGB) is commonly used in the treatment of morbid obesity. However, with clinical application and long-term follow-up, the shortcomings of this procedure were also exposed, bringing about surgery-related complications include dysphagia, intragastric band migration, slippage, and gastric band erosion. Lower esophageal and gastric fistula is a rare but dangerous complication after LAGB. We describe a case of esophagogastric fistula occurring twelve years after a laparoscopic band procedure and its successful management in a multidisciplinary and staged manner, followed by a short review of the literature.

BACKGROUND: The traditional bariatric surgery guidelines issued by the National Institute of Health in 1991 did not include moderate obesity as an indication for bariatric surgery. These patients also develop risk of significant comorbidity and mortality. Nonsurgical treatment for them is not generally effective. This study compared the results of patients undergoing laparoscopic adjustable gastric banded plication (LAGBP) with laparoscopic sleeve gastrectomy (LSG) in patients with BMI between 30 and 35.
METHODS: A review of data was done for patients who underwent either LAGBP or LSG in our hospital from February 2007 to October 2012. The inclusion criterion for both groups was BMI between 30 and 35 with or without comorbidity.
RESULTS: One hundred thirty-nine patients were included in the study out of which 42 underwent LAGBP and 97 LSG. The operating time for LAGBP was significantly longer: 105.39 ± 39 vs. 59 ± 29.56 min. The postoperative hospital stay was not statistically different between the two procedures. The mean percent excess weight loss (%EWL) was significantly lower for LAGBP at 1 year but became insignificant at 2 years. Both groups had two postoperative complications, but the rate was not statistically different. The comorbidity resolution data did not show any significant difference between the two groups.
CONCLUSIONS: In the present study, both LAGBP and LSG seemed to be safe and effective bariatric procedures in moderate obesity with 2-year results. But the long-term results are still awaited.

OBJECTIVE: To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding (LAGB) in obese patients.
METHODS: This retrospective study included 228 patients (73 males and 155 females, mean age, 32.5 ± 10.3 years) who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011. The body weight and postoperative complications were followed up.
RESULTS: The pre-operative mean body mass index (BMI) was 39.5 ± 6.3 kg/m(2). Except in one case of inadequate exposure of the stomach, all laparoscopic procedures were successfully accomplished, with no conversion to open surgery. The mean operation time was 65.0 ± 20.3 min. The mean hospital stay was 2.7 ± 0.9 days. Early postoperative complications (<30 days) occurred in five cases (2.2%) and late complications (>30 days) occurred in 75 cases (32.9%), including 56 cases (24.6%) with band-associated complications. The percentage of excess weight loss (EWL%) at 1, 3 and 5 years was 40.5 ± 30.5%, 59.5 ± 41.5% and 58.9 ± 46.4%, respectively. The percentages of patients with EWL% >25%, >50% and >75% were, respectively, 60%, 33% and 0% at 1 year follow-up, 43%, 39%, and 16% at 3 years follow-up and 40%, 34% and 16% at 5 years follow-up. CONCLUSION Although LAGB has low peri-operative mortality and morbidity rates, it is associated with a high late complication rate and unsatisfactory weight loss. It may be optional, but not the first choice, for the treatment of obesity.