Laparoscopic Adjustable Gastric Banding: Effect on gastroesophageal reflux, esophageal motility and gastric function

Abstract

Bariatric surgery is the only treatment option for individuals who have clinically severe obesity and are at the high risk for obesity-related mortality and co-morbidity. In order to get more insight in the effect of laparoscopic adjustable gastric banding on reflux, esophageal motility and gastric function, we started our studies in morbidly obese patients who were candidates for laparoscopic adjustable gastric banding in the St Antonius Hospital in Nieuwegein. The effect of laparoscopic gastric banding (LAGB) on gastroesophageal reflux was studied in 26 patients. They were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after operation. It was concluded that LAGB decreases gastroesophageal reflux if there is no pouch formation during follow-up. We studied the effect of LAGB on esophageal motility and lower esophageal sphincter functioning. Twenty-nine morbidly obese patients underwent conventional manometry preoperatively, six weeks postoperatively before and after filling the band and at six months postoperatively. We concluded that adjustable gastric band placement causes an increase in LES pressure and high pressure zone length. It decreases reflux symptoms on the short term but this effect appears not to be related with an effect on LES pressure or length. Band placement on the short term does not disturb propagation of esophageal contractions. The role of gastric emptying in the mechanism of weight loss and early satiety was studied in a series of patients who were scintigraphically investigated before and after LAGB. Sixteen patients undergoing LAGB underwent preoperatively and at six months postoperatively a gastric emptying study. It was concluded that LAGB seemed not to affect gastric emptying. Neither a relation between postoperative gastric emptying rate and weight loss, nor between early satiety and weight loss was found. Therefore, it is unlikely that gastric emptying plays a role in the mechanism of weight loss. The occurrence of esophageal dilatation after LAGB was investigated in 45 patients. They were assessed for the development of esophageal dilatation by standardised barium swallow studies carried out after the operation and after a mean follow-up period of 39.3 months. It was concluded that LAGB causes esophageal dilatation in about half of the patients. This dilatation is correlated with symptoms and is partly reversible after emptying of the band. We retrospectively analyzed the results of the LAGB procedure for morbid obesity in 411 patients. It was concluded that three quarters of the patients with morbid obesity who received LAGB surgery had achieved and sustained weight loss at 2 years following surgery. We performed a systematic review on the effect of LAGB on gastroesophageal reflux and esophageal motility. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. It was concluded that LAGB has anti-reflux properties resulting in resolution or improvement of reflux symptoms, normalized pH monitoring results and a decrease of esophagitis. However, worsening or newly developed reflux symptoms and esophagitis are found in a subset of patients during longer follow-up.