EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Hassanen et al
EFFICACY OF LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING IN
THE TREATMENT OF MORBID OBESITY
By
Ayman Hassanen, MD, Gamal Saleh, MD, Salah Abd EL-Raziq, MD
Department of General Surgery - Minia University
ABSTRACT:
Aim: To determine the long-term efficacy and safety of laparoscopic adjustable
gastric band (LAGB) in the treatment for morbid obesity and to detect whether age,
gender, or preoperative body mass index (BMI) has an impact on the outcome.
Patients and methods: All consecutive patients who had a LAGB inserted between
October 2004 and October 2006 were evaluated prospectively at Department of
General Surgery, Minia University Hospitals.
Results: There were 32 females (78%) and 9 males (22%), with mean age 41.3±11,
mean BMI 42.8±7.3 kg/m2. LAGB was successfully inserted in 39 of 41 included
patients (95%). Mean operative time was 65± 30 minutes. The main complication was
port leak in 4 patients (9.6%). The mean preoperative BMI was 42.8±7.3 versus
30±2.1 at 36 months postoperatively (Paired student “t” test, P<0.05). The mean
preoperative weight was 118.3±22.9 versus 78±11.4 postoperatively (Paired student
“t” test, P<0.05)
There was no statistically significant difference in weight loss between different age
groups up to 36 months after the band placement. Postoperative BMI at 36 months
was 29.5±2.1 in age group (20-30y), 30±1.9 in age group (30-40y) and 30±3.9 in age
group (40-50y), (One way ANOVA, P>0.05). The postoperative BMI was not
affected by gender. Postoperative BMI at 36 months was 30±2.9 in males versus
29±2.9 in females (Student “t” test, P>0.05). The postoperative BMI was not affected
by different preoperative BMI groups. At 36 months, postoperative BMI was 29.4±2.4
in BMI group (30-40), 30±1.6 in BMI group (40-50) and 31±3.9 in BMI group (5060) (One way ANOVA, P>0.05).
Conclusion: The LAGB is effective in achieving long-term sustainable weight loss
with an acceptably low complication rate. Bands are effective regardless of patient’s
age, gender and BMI.
KEY WORDS:
Laparoscopy
Morbid obesity
Bariatric surgery
lung dysfunction, and psychological
disease3. Bariatric surgery is the only
evidence-based approach to achieving
sustainable weight loss in morbidly
obese adults4. The laparoscopic
adjustable gastric band (LAGB) is the
most commonly used bariatric procedure. Alarmingly, obesity often starts
in childhood5. The Swedish adjustable
gastric band (SAGB) was introduced in
Sweden in 19856 and it has been
INTRODUCTION:
Obesity is a growing public
health concern in the world. According
to a recent study by the Research and
Development (RAND) organization,
obesity is more damaging to health
than smoking, high levels of alcohol
consumption, or poverty1-2. This is due
to its multiple co-morbid diseases,
including diabetes, cardiovascular
disease, musculoskeletal disorders,
49
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
estimated that more than 120,000
gastric bands have been placed
worldwide. There are numerous studies
presenting their short-term efficacy7,8.
However, despite a large experience in
different centers, few publications have
reported long-term efficacy of the
LAGB9–10. Additionally, there is
controversy in the literature as regard
the impact of age, sex, and initial BMI
at 3 years after LAGB. Our study
reports the results in a series of 41
patients as regards of their preoperative
age, gender, and BMI at long-term
follow-up (3 years).
Hassanen et al
potential risks, and complications at
operation and in the postoperative
period. A written informed consent
was taken from all patients. Preoperative investigations performed
included gastroscopy, base-line hematological and biochemical investigations and abdominal ultrasound to
document the presence of gallstones.
The operation was done under general
anesthesia. The patient was placed in
the lithotomy position with reverse
Trendelenburg to approximately 40○.
The pneumoperitoneum was initiated
and 6 ports were placed. We used the
open visual access with a 10 mm
Optiview trocar with a 0 telescope to
allow access then it was replaced by
telescope 30○. The Optiview trocar was
placed laterally just below the left
costal margin. The abdomen was
insufflated to 15 mm Hg and additional
ports were placed under direct vision
including two 5 mm right sub costal
ports, a 5 mm upper midline port, 18
mm left upper quadrant paramedian
port and a 5 mm left upper quadrant
port. The pars flacida in the
hepatogastric ligament was incised
(Fig 1, 2) close to the esophago-gastric
junction. Then the right crus was
visualized (Fig 3) after incision of the
covering peritoneum. After minimal
blunt and sharp dissection of the angle
of Hiss to visualize the left crus (Fig
4), the retro-gastric tunnel was created
below the esophago-gastric junction
with the help of golden finger (Ethicon
Endo Surgery) and the band (SAGB,
Ethicon Endo Surgery) or (Lap-band,
Allergan) was pulled behind the
stomach after being introduced into the
abdomen via the 18 mm trocar. After
closing the band (Fig 5), a proximal
gastric pouch of about 10 to 15 ml was
created and secured with three to four
non-absorbable gastro-gastric sutures
(Fig 6) to avoid band slippage and
pouch dilatation. After pulling out the
tube, the pneumoperitoneum was
PATIENTS AND METHODS:
All morbidly obese patients
who had a LAGB placed at General
surgery Department of Minia University Hospitals from October 2004 to
October 2006 were included, and their
data recorded prospectively. The
placement of LAGB was undertaken in
patients who were referred for bariatric
surgery. The indications for bariatric
surgery were based on a number of
parameters that included BMI,
previous significant attempts to lose
weight by dietary means, and the
presence of significant co-morbidities.
BMI criteria were those defined by
National Health and Medical Research
Council11 (BMI more than 40 or 35
with 1 or more co-morbidities). In
addition, patients between BMI 30 and
35 were included if co-morbidities
such as diabetes and sleep apnea were
difficult to manage without weight
reduction and could not be achieved by
nonsurgical means. Exclusion criteria
included inability to understand
necessary intensive follow-up and
operative procedures, untreated psychiatric disorders. All patients received
multidisciplinary (medical, nutritional,
psychological, and surgical) screening
and education before surgery. Patients
were
informed
about
dietary
requirements, follow-up protocol,
50
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
released and the tube was connected to
the port anterior to the rectus sheath.
Hassanen et al
for two independent samples and a
paired t-test for paired observations
except where otherwise noted. Data
were analyzed using SPSS 10 for
windows and One-Way ANOVA. P
value of less than 0.05 was considered
to indicate statistical significance.
After starting fluid intake on
the first postoperative day, a
gastrograffin swallow was performed
on the second postoperative day and
the patient was discharged on the third
postoperative day. Patients were seen
by one of the treating physicians for
band adjustments at 6 weeks and then
every 3 months or as needed
throughout the year and weighed at
each visit. Most adjustments were
performed by direct palpation.
RESULTS:
Between October 2004 and
October 2006, 41 patients who
underwent placement of LAGB at
Department of General Surgery, Minia
University Hospitals were prospectively evaluated.
Early postoperative complications were those occurring within 30
days of the operation.
Demographics:
There were 32 females (78%)
and 9 males (22%), with the mean
preoperative age of 41.3±11 years.
Twelve patients (29.2%) had previous
cholecystectomy and 9 patients
(21.9%) had a history of previous
pelvic operations. Patient demographics were shown in Table 1.
Long-term complications were
those occurring after 30 days of the
operation. Patients were considered to
be lost to follow-up if they had not
been reviewed in the previous 6
months.
Operation:
In this series, successful
laparoscopic gastric banding was done
in 39 of 41 included patients (95%)
Mean operative time was 65± 30
minutes; it was 115±35 min for the
first 20 patients and 55±25 min for the
second 21 patients. Conversion to
laparotomy was necessary in 2 patients
(4.8%). These conversions took place
early in the first year of the start of the
study. Conversions were required in
two patients (4.8%) due to adhesions
from previous surgery and enlarged
left lobe of the liver with difficulty in
its retraction. There was no blood
transfusion required in any patient. An
additional operation was performed in
10(24.3%) of the patients; 6 (14.6%)
hiatus hernia repair was performed by
the approximation of the crura, at the
time of band placement; 4 patients
(9.7%) with known gallstones before
surgery underwent simultaneous lapa-
Efficacy of the surgery was
determined by measure-ment of change
in the percentage excess weight loss
(%EWL), BMI, and absolute weight
change in kilograms over the follow-up
period. The classification developed by
Reinhold12 was used to define the
outcome. Success was defined as EWL
more than 50%, whereas failure was
defined as EWL less than 50%. The
effect of preoperative BMI, age, and
gender on outcome was evaluated.
STATISTICAL METHODS:
Descriptive data were expressed as mean + standard deviation or
medians and ranges for continuous
variables and as number and percent
for categorical variables. Comparisons
of discrete variables were analyzed
with Fishers
exact
test,
and
comparisons of continuous variables
were analyzed with a two-sample t-test
51
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Hassanen et al
roscopic cholecystectomy during the
gastric banding procedure.
was no deep venous thrombosis,
pulmonary embolism.
Operative Morbidity:
Operative complications occurred in 2 patients (4.8%). Accidental
laceration of the left hepatic lobe
occurred in 1 patient (2.4%), which
spontaneously resolved. In addition,
there was one patient with bleeding
around the spleen (2.4%), which
stopped on application of local
pressure.
Weight loss:
The mean preoperative BMI
was 42.8±7.3 versus 30±2.1 at 36
months
postoperatively
(P<0.05,
Paired student “t” test). The mean preoperative weight was 118.3±22.9 versus 78±11.4 postoperatively (P<0.05,
Paired student “t” test).
The postoperative BMI was not
affected by different age groups. There
was no statistically significant differrence in weight loss between different
age groups up to 36 months after the
band placement. Postoperative BMI at
36 months was 29.5±2.1 in age group
(20-30y), 30±1.9 in age group (30-40y)
and 30±3.9 in age group (40-50y)
(P>0.05, One way ANOVA).
Early postoperative Morbidity:
Early complications occurred
within the first month after surgery.
These included wound infection in 2
patients (4.8%), port infection in 2
patients (4.8%), Table 2. Wound
infections responded to postoperative
oral antibiotics for 1 week. In patients
with port site infection, the port was
removed, and patients treated with
antibiotic and local antiseptic until the
infection cleared and the wound
healed. The injection port was
reinserted after 3 months.
The postoperative BMI was not
affected by gender. Postoperative BMI
at 36 months was 30±2.9 in males
versus 29±2.9 in females (P>0.05,
Student “t” test).
The postoperative BMI was not
affected by different preoperative BMI
groups. Postoperative BMI at 36
months was 29.4±2.4 in BMI group
(35-40), 30±1.6 in BMI group (40-50)
and 31±3.9 in BMI group (50-60)
(P>0.05, One way ANOVA).
Late postoperative Morbidity:
Late complication included one
anterior slipped band (2.4%). The band
was repositioned via laparoscopy, and
the patient has remained well.
There were one (2.4%) band erosion
and 4 port or catheter leaks (9.7%),
Table 2. Band erosion within the
stomach clinically presented with loss
of restriction from the band. Erosion
was diagnosed endoscopically (Fig 7)
and treated by removal of the band
laparoscopically.
Two
patients
developed gallstones (4.8%). There
Using the Reinhold12 classification to distinguish excellent and
poor weight loss, more than 70% of the
patients lost more than 50% of their
excess weight after 3 years of surgery.
52
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Hassanen et al
Table 1: Patients demographics
Character
Number
Mean age±SD (years)
Mean weight±SD (Kg)
Mean height±SD (cm)
Mean BMI±SD (Kg/m2)
Mean excess weight±SD (Kg)
Age groups:
20-30 years
30-40 years
40-50 years
Preoperative BMI groups:
30-40
40-50
50-60
History of cholecystectomy
History of pelvic operation
Value
41 (32/9)
41.3±11
118.3±22.9
168±21.2
42.8±7.3
55.2±20.7
9 (22%)
22 (54%)
10 (24%)
15 (36%)
20 (49%)
6 (15%)
12 (29.2%)
9 (12.9%)
Table 2: Complication
Complication
Wound infection
Port infection
Port leak
Band slippage
Band erosion
Gall stone formation
Number (%)
2 (4.8)
2 (4.8)
4 (9.6)
1 (2.4)
1 (2.4)
2 (4.8)
53
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Hassanen et al
Fig 1: Incision of the pars flacida in the hepatogastric ligament.
Fig 2: The pars flacida after openining
Fig 3: Incision of the peritoneum over the right crus
54
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Fig 4: Incision of the peritoneum over the left crus
Fig 5: The band after its closure
Fig 6: The band was secured by gastro-gastric sutures
55
Hassanen et al
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
Hassanen et al
Fig 7: Endoscopic diagnosis of band erosion
as rapid as seen after operations such
as gastric bypass where up to 70% of
excess weight is lost.17 However, with
the passage of time the weight loss and
sustainability of %EWL with gastric
bypass decreases and by 3 years and
beyond it approaches the 60% value.18
This result at 3 years is similar to that
reported in our study and suggests that
in terms of efficacy over a prolonged
period there may be little difference
between treatments via SAGB versus
gastric bypass. Prospective randomized
studies may answer this question, but
other parameters as safety, cost
effectiveness, availability of procedures, and patient acceptability may
determine what is offered to specific
patients.
DISCUSSION:
The physiologic improvements
that result from even modest weight
loss have been well documented. The
10% of excess weight loss has been
shown to improve obstructive sleep
apnea, cardiovascular risk, inflammation, thromboembolic risk, and serum
glucose concentration. In addition to
improving physiologic parameters,
modest weight loss may even reduce
intraabdominal adiposity with reduction of both intraabdominal and
intrahepatic fat.13
Effective long-term weight
reduction can be achieved in obese
patients following insertion of a soft
adjustable gastric band such as the
SAGB. On long-term follow-up more
than 70% of patients had a sustainable
weight loss of greater than 50% of
their excess weight. These results are
similar to other series using the
adjustable gastric band.14,15 In addition,
it illustrates that the effectiveness that
had previously been demonstrated,16 is
sustained up to 3 years. Weight loss
with the SAGB in the first year is not
The relative safety of bariatric
surgery using the adjustable gastric
band is illustrated by the results of this
study. Band slippage was a major
complication after use of perigastric
approache19. After the operative
technique was changed from perigastric to pars flaccida placement of the
band, this complication has become
56
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
uncommon20. The results of this study
are similar to patients with pars flacida
approach20.
Hassanen et al
no effect on long-term efficacy for
weight loss. This is contrary to a
Branson et al study27 that demonstrated
a similar overall weight reduction but
showed that the procedure was more
effective in younger women when
compared with older men. Hence, age
and gender do not seem to be a major
discriminator for success. Initial BMI
also has been thought to select patients
for the different procedures. In this
study, there was no difference demonstrated in efficacy in patients with
different BMI. The relatively slow rate
of weight loss produced by the SAGB
may account for the low prevalence of
postoperative gallstone formation. In
patients having gastric bypass symptomatic gallstones were reported in up to
14% of patients28. In this series only
4.8% developed gallstones. It has
previously shown that the rate of
weight reduction affects gallbladder
motility and a weight reduction rate in
excess of 1 kg per week is associated
with reduced gallbladder emptying.29
Changes in the co-morbidities of
obesity have not been evaluated for
this series of patients. A number of
other series have demonstrated the
therapeutic impact of weight reduction
on the co-morbidities of diabetes30,
hypertension30, sleep apnea31, and the
metabolic syndrome.32 Furthermore,
patients who lose weight in excess of
25% of excess weight generally have
positive quality of life scores.33
Conclusion: The gastric banding is
effective in achieving long-term sustainable weight loss with an acceptably
low complication rate. Bands are
effective regardless of patients’ age,
gender, and BMI
Erosion of the band into the
stomach remains a major complication
affecting 2.4% of the patients. This
complication has been treated by the
removal of the band via the endoscopic
or laparoscopic approach, which
subsequently permits either reinsertion
of an adjustable gastric band or another
bariatric procedure.21 The cause of
band erosion is unknown.21 However,
it is associated with excessive fluid in
the band, which may produce ischemia
of
the
underlying
stomach.22
Alternatively, erosion may start as an
ulcer of the mucosa and this may erode
towards the band.23 In other series
there is a suggestion that it may be
associated with infection of the port,
the connecting tubing, or the band
itself.24 A clear relationship of causes
has not been demonstrated in our
study, and no single factor has been
identified to cause band erosion.
Reservoir port site infection
was another common complication.24
This complication occurred within the
30 days of the postoperative period.
Control of the infection occurred only
after removal of the infection port. In
these instances the port was reinserted
3 months after removal and when the
infection had resolved. Operative
mortality associated with the insertion
of an adjustable gastric band is low and
significantly lower to that reported for
other bariatric operations25. This result
makes this operation attractive to
patients, even though the initial weight
reduction may not be as rapid as that
experienced by the more invasive
procedures such as gastric bypass.
Patient demographics and initial BMI
has been suggested as a mean to select
patients for the different bariatric
procedures.26 In this study, gender had
REFERENCES
1. Sturm R. The effects of obesity,
smoking, and problem drinking on
chronic medical problems and health
care costs. Health Affairs 2002; 21:
245-53.
57
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
2. Sturm R, Wells KB. Does
obesity contribute as much to
morbidity as poverty or smoking?
Public Health 2001; 115: 229-35.
3. Alvarado R, Alami R, Hsu G,
Safadi B, Sanchez B, Morton M, Curet
M. The impact of preoperative weight
loss in patients undergoing laparoscopic Roux-en-Y gastric bypass
obesity surgery 2005; 15, 1282-1286
4. Douketis JD, Feightner JW,
Attia J. Detection, prevention and
treatment of obesity. CMAJ 1999;
160:513–25
5. Booth ML, Chey T, Wake M.
Change in the prevalence of
overweight and obesity among young
Australians, 1969–1997.Am J Clin
Nutr. 2003; 77:29 –36
6. Hallberg D, Forsell P. Balloon
band for treatment of massive obesity.
Sevenk kirurgi. 1985; 43:106
7. Fielding GA, Rhodes M,
Nathanson LK. Laparoscopic gastric
banding for morbid obesity. Surgical
outcome in 335 cases. Surg
Endosc.1999; 13:550 –554
8. Ceelen W, Walder J, Cardon A.
Surgical treatment of severe obesity
with a low-pressure adjustable gastric
band: experimental data and clinical
results in 625 patients. Ann Surg.
2003;237:10 –16.
9. Balachew M, Belva PH,
Desaive C. Long-term results of
laparoscopic adjustable gastric banding
for the treatment of morbid obesity.
Obes Surg. 2002; 12:564 –568
10. Weiner R, Blanco-Engert R,
Weiner S. Outcome after laparoscopic
adjustable
gastric
banding-years
experience. Obes Surg. 2003; 13:427–
434
11. National health and medical
research council (NHMRC). National
clinical guidelines for weight control
and obesity management in adults.
NHMRC, 2002.
12. Reinhold RB. Critical analysis
of long term weight loss following
Hassanen et al
gastric bypass. Surg Gynecol Obstet.
1982; 155:385–394
13. Adams JP, Murphy PG.
Obesity in anesthesia and intensive
care. Br J Anaesth. 2000; 85:91–108
14. Chapman B, Foster B, Kiroff
G. Laparoscopic adjustable gastric
banding in the treatment of obesity: a
systematic literature review. Surgery.
2004; 135:326 –351
15. O’Brien PE, Dixon JB, Brown
W. Obesity is a surgical disease:
overview of obesity and bariatric
surgery. ANZ J Surg. 2004; 74:200 –
204
16. Steffen R, Bierthol L, Ricklin
T. Laparoscopic Swedish adjustable
gastric band: a five-year postoperative
study. Obes Surg. 2003; 13:404–411
17. Sugerman HJ, Kellum JM,
Engle KM. Gastric bypass for treating
severe obesity. Am J Clin Nutr. 1992;
55(suppl 2): 560S–566S.
18. Zehetner J, Holzinger F, Triaca
H. A 6-year experience with the
Swedish adjustable gastric band
prospective long-term
audit of
laparoscopic gastric banding. Surg
Endosc. 2005; 19:21–28
19. Buchwald H, Williams SE.
Bariatric surgery worldwide 2003.
Obes Surg.2004; 14:1157–1164
20. Greenslade J, Kow L, Toouli J.
Surgical management of obesity using
a soft adjustable gastric band. ANZ J
Surg. 2004; 74:195–199
21. Fobi M, Lee H, Igwe D. Band
erosion:
incidence,
etiology,
management and outcome after banded
vertical gastric bypass. Obes Surg.
2001; 11:699 –707
22. Eric M, Mark VB. Adjustable
silicone gastric banding and band
erosion: personal experience and
hypotheses. Obes Surg. 1999; 9:191–
193.
23. Angrisani L, Furbetta F, Dolodi
SB. LAGB; the Italian experience with
1863 patients operated in 6 years. Surg
Endosc. 2003; 17:409–412
58
EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009
24. Podnos YD, Jimenez JC,
Wilson SE. Complications after
laparoscopic gastric bypass: a review
of 3464 cases. Arch Surg. 2003;
138:957–961
25. Philips ML, Kow L, Toouli J.
Change in liver size and fat content
after treatment with Optifast very low
calorie diet. Obes Surg. 2006; 16: 697–
701
26. Polliand C, Rizk N, Barrat C.
Are there predictive items of
successful surgery in morbid obesity
treated by adjustable gastric banding: a
prospective study. Ann Chir. 2005;
130:318 –322
27. Branson R, Potoczna N,
Brunotte R. Impact of age, sex, and
BMI on outcomes at four years after
gastric banding. Obes Surg. 2005; 15:
834–842.
28. Jan J, Hong D, Pereira N.
Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass
for morbid obesity: a single-institution
comparison study of early results.
Gastrointest Surg. 2005; 9:30 –39
29. Al-Jiffry B, Toouli J, Saccone
GTP. Changes in gallbladder motility
Hassanen et al
and gallstone formation following
laparoscopic gastric banding for
morbid obesity. Can J Gastroenterol.
2000; 17:169 –174
30. Spivak H, Hewitt MF, Onn A.
Weight loss and improvement of
obesity-related illness in 500 U.S.
patients
following
laparoscopic
adjustable gastric banding procedure.
Am J Surg. 2005; 189:27–32
31. Dixon JB, Schachter LM,
O’Brien PE. Sleep disturbance and
obesity: changes following surgically
induced weight loss. Arch Intern Med.
2001; 161:102–106
32. Matter SG, Velcu
LM,
Rabinovitz M. Surgically induced
weight loss significantly improves
nonalcoholic fatty liver disease and the
metabolic syndrome. Ann Surg. 2005;
242:610–617; discussion 618–620
33. Champault A, Duwat O,
Polliand C. Quality of life after laparoscopic gastric banding: prospective
study (152 cases) with a follow-up of 2
years. Surg Laparosc Endosc Percutan
Tech. 2006; 16:131–136
59
‫‪Hassanen et al‬‬
‫‪EL-MINIA MED., BULL., VOL. 20, NO. 1, JAN., 2009‬‬
‫تأثير تركيب حزام المعدة بالمنظار الجراحي في عالج السمنة المفرطة‬
‫أيمن حسانين‪ -‬جمال صالح ‪ -‬صالح عبد الرازق‬
‫قسم الجراحة العامة بكلية طب المنيا‬
‫إن الهدف من هذه الدراسه هو تقييم الدور طويل المدي لتركيب حزام المعده في عالج السمنة‬
‫المفرطة وكذلك لتحديد اذا كان هناك تأثير لعامل العمر والجنس ومعدل السمنة على نتائج‬
‫العملية‪ .‬وتم اجراء هذه الدراسه فى قسم الجراحة العامة بمستشفى المنيا الجامعى فى الفترة‬
‫من أكتوبر ‪ 2004‬الى أكتوبر ‪ 2006‬وكانت النتائج كما يلى‪:‬‬
‫بلغ عدد المرضى ‪ 32‬مريضة (‪ )%78‬وعدد ‪ 9‬مرضى رجال (‪ )%22‬وقد تم تركيب حزام‬
‫المعده بالمنظار الجراحي بنجاح فى عدد ‪ 39‬من عدد ‪ 41‬مريضا (‪ )%95‬وكان متوسط وقت‬
‫العمليه ‪ 65‬دقيقة وحدث تسريب في مكان الصمام في عدد ‪ 4‬مرضى (‪ )%9.6‬وكان معدل‬
‫السمنة قبل العملية ‪ 42.8 ±7.3‬مقارنة بالرقم ‪ 30 ±2.1‬بعد ‪ 36‬شهرا بعد العملية حيث كان‬
‫ذلك ذو داللة إحصائية‪ .‬وكان متوسط الوزن قبل العملية‪ 118 ±22.9‬كيلوجرام مقارنة بالرقم‬
‫‪ 78±11.4‬بعد ‪ 36‬شهرا من العملية حيث كان ذلك ذو داللة إحصائية‪.‬‬
‫وبالمتابعه التى امتدت ‪ 36‬شهرا حيث لم يكن هناك فارق في معدل السمنة بتغير عامل العمر‬
‫اوالجنس اومعدل سمنة ما قبل العملية‪.‬‬
‫وقد تم استنتاج ان تركيب حزام المعدة بالمنظار الجراحي في عالج السمنة المفرطة يعتبر‬
‫طريقه ناجحه النقاص الوزن لمدى طويل وبنسبة مضاعفات قليلة ونتائجها ال تتغير ببتغير‬
‫عامل العمر او الجنس او معدل سمنة ما قبل العملية ‪.‬‬
‫‪60‬‬