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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Systematic review of erosion after laparoscopic adjustable gastric banding

K Egberts, WA Brown, and PE O'Brien.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

The review concluded that re-banding after erosion (and there was a low incidence of erosion) in laparoscopic adjustable gastric banding patients resulted in low re-erosion rates and maintenance of weight loss. However, the evidence was generally considered to be poor and limited conclusions could be drawn. The authors’ conclusions reflect the evidence presented and seem reasonable.

Authors' objectives

To investigate the incidence, clinical features and management of erosions occurring after laparoscopic adjustable gastric banding.

Searching

MEDLINE, AMED, CINAHL, and Evidence Based Medicine Reviews were searched; some search terms were reported. The search was restricted to the last 15 years (precise dates were not reported). Two journals (Obesity Surgery and Surgery for Obesity and related Disorders) were handsearched. References from the included studies were checked for additional relevant studies.

Study selection

Studies of obese (body mass index over 30), post-surgical laparoscopic adjustable gastric banding patients (aged between 18 and 60 years) were eligible for inclusion. Eligible studies had to report the incidence of erosion and at least one outcomes of clinical presentation, aetiology, operative complications, weight loss, or operative infection. All clinical reports where an erosion was described within three months of the operative procedure were excluded.

Most included studies involved the LAP-BAND system; three studies used the Swedish Adjustable Band. The mean baseline body mass index was 42.2 (± 9.4). Erosion was detected by endoscopy. Treatment of erosion was typically removal of the band, but some patients underwent band replacement and others converted to another bariatric procedure. Reasons for erosion varied, including intraoperative events and patient characteristics. Studies were published from 1998 to 2010.

The authors did not explicitly report how many reviewers selected studies for the review but did state that methodological processes were performed according to the Cochrane method for systematic reviewing.

Assessment of study quality

The authors stated that the methodological quality of the included studies was assessed using Cochrane techniques. No further details were reported.

Data extraction

The incidence of erosions and other outcomes were extracted including data to calculate mean differences (MD) for weight loss outcomes and their associated 95% confidence intervals (CIs).

The authors stated that methodological processes were performed according to the Cochrane method for systematic reviewing.

Methods of synthesis

Where significant homogeneity was found between studies, weight loss outcomes were pooled using a random-effects model; summary estimates were reported as standardised mean differences (SMDs) and 95% confidence intervals.

Multiple regression analysis was used to describe associations between erosions, time and surgeon experience.

Other results were presented in a narrative format due to heterogeneity.

Results of the review

Twenty-five case series studies were included in the review (15,775 patients). The mean number of patients per study was 631 (±486). The mean follow-up was 3.73 years (±2.4).

The incidence of erosions ranged from 0.23% to 32.65%.

Treatment of erosion: Two small case series studies suggested that delayed reinsertion was associated with lower a rate of re-erosion compared with immediate replacement. Two case series studies that used conversion to another bariatric procedure reported complications including wound infection, anastomotic leak and death. Few serious postoperative complications following erosion treatment, as well as few complications after band removal, gastric wall repair and replacement (whether immediate or delayed) were reported. Complications included wound infection, abdominal pain, and gastric fistula (17 studies).

Weight change after treatment of erosion: Weight loss was maintained following treatment for erosions across studies with patients who experienced erosion (mean percentage excess weight loss 50.34 (± 3.9%) at final follow-up. Significantly greater mean percent excess weight loss was found in studies with low rates of erosion (below 1.5 incidence) when compared with studies with high erosion rates (over 3%). When subdivided by treatment type, continuing weight loss was best in patients undergoing delayed replacement (48.7%) compared with immediate replacement (45.2%), conversion (41.4%), and explantation (40%). These results did not reach statistical significance.

Authors' conclusions

The findings supported a low incidence rate of erosion in laparoscopic adjustable gastric banding patients. With re-banding after erosion, re-erosion rates were low and weight loss was maintained at a rate equivalent to other bariatric procedures. However, the evidence was generally considered to be poor and limited conclusions could be drawn.

CRD commentary

The review question was supported by clear inclusion criteria. Several sources were searched, although no attempts were made to identify unpublished studies; it was not clear whether this search was restricted by language. The authors reported that there was evidence of substantial publication bias. It appeared that steps were taken to minimise the likelihood of reviewer error or bias in the review process.

The methodological quality of included studies was assessed. Although individual results were not reported, the overall quality of the evidence was considered to be poor. Due to the heterogeneity evident between the included studies, a largely narrative synthesis was presented.

Given the quality of the evidence base and possible publication bias, the authors’ statement that limited conclusions could be drawn seems reasonable.

Implications of the review for practice and research

Practice: The authors suggested that their preferred approach would be a delayed replacement of the gastric band after erosion as this led to fewer subsequent erosions.

Research: The authors did not state any implications for research.

Funding

The Centre for Obesity Research and Education supported by an unrestricted grant from Allegran (the manufacturer of the Lap-Band); Applied Medical, USA.

Bibliographic details

Egberts K, Brown WA, O'Brien PE. Systematic review of erosion after laparoscopic adjustable gastric banding. Obesity Surgery 2011; 21(8): 1272-1279. [PubMed: 21547403]

Indexing Status

Subject indexing assigned by NLM

MeSH

Device Removal; Foreign-Body Migration /diagnosis /epidemiology /surgery; Gastroplasty /instrumentation /methods; Humans; Laparoscopy; Obesity, Morbid /surgery; Postoperative Complications /diagnosis /epidemiology /surgery; Prostheses and Implants /adverse effects; Regression Analysis; Reoperation; Silicones

AccessionNumber

12011006001

Database entry date

15/06/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21547403

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