Redefining the role of radiology in the postoperative management of laparoscopic adjustable gastric banding (LAGB).

Background: Upper gastro-intestinal series (UGI) are routinely employed in early and late postoperative management of LAGB patients, with the aim to assess early or late complications and to perform band adjustment.We here report the prospective results of our series in order to redefine the role of radiology in the postoperativemanagement. Methods: From September 1993 through January 2006, 2000 patients had LAGB at our hospital. In 2000 we abandoned routine UGI series in all patients at post-op day 1. Since then, 869 UGI were performed on 373 patients (295 F, 78 M, average age 40 (16-67) years) who were either symptomatic (early and late postoperatively) or had inadequate weight loss. We compared these patients with a control group of 38 subjects undergone yearly UGI after LAGB with satisfactory weight loss and uneventful follow-up. Results: No postoperative mortality or gastric perforation was reported. Major postoperative complications included 21 (5.6%) late large-volume gastric slippage (127.4 + 52.3 mL) with outlet obstruction and 15 (4%) middle volume (39.46 + 23.32 mL) with patent outlet. 12% of these patients were operated via perigastric approach while 2% via pars flaccida. In the control group a little gastric pouch (9.9 + 12 mL) without clinical relevance was observed in 13.2%. Tube disconnection was reported in 16 cases (4.3%) who experienced acute loss of satiety, while none in the control group. Conclusion: An extensive radiological protocol is unnecessary for the postoperative management of LAGB, since a prompt customized approach allows a safer and better treatment of patients with complications or insufficient weight loss. Only large and middle slippages mandate re-do surgery.