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Brugge, Belgium

Agrawal S.,University of London | Van Dessel E.,AZ Sint Jan Hospital AV | Akin F.,AZ Sint Jan Hospital AV | Van Cauwenberge S.,AZ Sint Jan Hospital AV | Dillemans B.,AZ Sint Jan Hospital AV
Obesity Surgery | Year: 2010

Isolated laparoscopic sleeve gastrectomy is increasingly being used for the treatment of morbid obesity. However, doubts still persist regarding long-term weight loss, and the 5-year results are awaited. Whether the aetiology of failed excess weight loss is the result of an inadequate sleeve or attributable to dilatation of the sleeve is not clear. In an effort to prevent gastric dilatation and increase gastric restriction to promote further weight loss in the long term, we performed a combined procedure of laparoscopic adjustable gastric banding with sleeve gastrectomy. The patient was a 39-year-old woman with a life-long history of obesity and a body mass index of 79.8 kg/m 2. The surgical technique of the laparoscopic adjustable gastric banded sleeve gastrectomy is described. There were no immediate complications, and the patient was discharged home on the third postoperative day. She is doing extremely well on clinic follow-up at 6 weeks. To the best of our knowledge, laparoscopic adjustable gastric banded sleeve gastrectomy, as a primary operation, has not been described in the literature. It is hoped that this combined procedure will be most useful in the super-super obese (body mass index∈>∈60) patients. More patients with a long-term follow-up are necessary to provide definitive conclusions regarding long-term benefits and complications of this combined bariatric procedure. © 2010 Springer Science + Business Media, LLC. Source


Dillemans B.,AZ Sint Jan Hospital AV | Van Cauwenberge S.,AZ Sint Jan Hospital AV | Agrawal S.,University of London | Van Dessel E.,AZ Sint Jan Hospital AV | Mulier J.-P.,AZ Sint Jan Hospital AV
BMC Surgery | Year: 2010

Background. Currently, there is no consensus opinion regarding the optimal procedure of choice in super-super-morbid obesity (Body mass index, BMI > 60 kg/m2). Roux-en-Y gastric bypass (RYGB) is associated with failure to achieve or maintain 50% excess weight loss (EWL) or BMI < 35 in approximately 15% of patients. Also, percent EWL is significantly less after 1-year in the super-super-obese group as compared with the less obese group and many patients are still technically considered to be obese (lowest post-surgical BMI > 35) following RYGB surgery in this group. The addition of adjustable gastric band (AGB) to RYGB has been reported as a revisional procedure but this combined bariatric procedure has not been explored as a primary operation. Methods. In a primary laparoscopic RYGB, an AGB is drawn around the gastric pouch through a small opening between the blood vessels on the lesser curve and the gastric pouch. The band is then fixed by suturing the gastric remnant to the gastric pouch both above and below the band to prevent slippage. Results. Between November 2009 and March 2010, 6 consecutive super-super-obese patients underwent a primary laparoscopic adjustable banded Roux-en-Y gastric bypass procedure at our institution. One male patient (21 years, BMI 70 kg/m) developed a pneumonia postoperatively. No other postoperative complications were observed. Conclusion. To the best of our knowledge, this is the first series of patients that underwent a laparoscopic adjustable banded RYGB as a primary operation for the super-super obese in the indexed literature. With the combined procedure, a sequential action mechanism for weight loss is to be expected. The restrictive, malabsorptive and hormonal working mechanism of the RYGB will induce weight loss from the start reaching a stabilised plateau of weight after 12 - 18 months. At that time, filling of the band can be started resulting in further gastric pouch restriction and increased weight loss. Moreover, besides improving the results of total weight loss, a gradual filling of the band can as well prevent the RYGB patient from weight regain if restriction would fade away with time. © 2010 Dillemans et al; licensee BioMed Central Ltd. Source


De Backer O.,Ghent University | Debonnaire P.,AZ Sint Jan Hospital AV | Debonnaire P.,University Hospital Leuven | Muyldermans L.,AZ Sint Jan Hospital AV | Missault L.,AZ Sint Jan Hospital AV
Acta Clinica Belgica | Year: 2011

In this report, we describe a case of Tako-Tsubo cardiomyopathy (TTC) - also called 'apical ballooning' syndrome - in which transient left ventricular outfl ow tract (LVOT) obstruction and mitral regurgitation led to haemodynamic instability. Patients with hypotension should undergo urgent echocardiography to determine if LVOT obstruction is present. This complication has been described in 10-25% of all TTC patients. In patients with hypotension and moderate-to-severe LVOT obstruction, inotropic agents should not be used because they can worsen the degree of obstruction. Instead, it is suggested to use β-blockers, which can improve haemodynamics by causing resolution of the obstruction. The fact that some patients do not survive their acute TTC event only underscores the importance of prompt recognition and targeted management of dynamic LVOT obstruction. Source

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