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1/2. Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome.

    In a remarkably short time, Laparoscopic Adjustable Gastric Banding (LAGB) has become a common operation for morbid obesity in europe and elsewhere. More than 70,000 such procedures have been performed in recent years. We used LAGB as a routine treatment for morbid obesity in 90 patients between 1994 and 1996. We agree with other authors that LAGB is the least invasive of all gastric restrictive procedures, resulting in a low perioperative mortality and morbidity. The weight loss appears to be similar to that obtained by vertical banded gastroplasty (VBG). However, our long-term follow-up studies, including endoscopic examinations, as well as recent data in the literature also indicate a number of significant problems with LAGB. Patient discomfort occurs frequently in the postoperative course. When questioned according to a standardized protocol 2 years after surgery, every other patient in our series admitted heartburn and acid regurgitation. Regular endoscopic surveillance revealed a prevalence of erosive esophagitis of 44%. After a median follow-up of 7 years, 58% of the patients had been reoperated on, almost always with excision of the banding system and conversion to Roux-en-Y gastric bypass (RYGBP). The reasons for reoperation were esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation, complications that also have been described in several recent papers in the literature. Our prediction is that LAGB will not stand the test of time.
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ranking = 1
keywords = discomfort
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2/2. Recurrent autonomous esophageal peristalsis in patients with chest discomfort.

    Routine esophageal manometry revealed a novel pattern of esophageal motility, recurrent autonomous peristalsis, in five patients evaluated for chest discomfort and heartburn. In the absence of swallowing, esophageal peristalsis occurred at frequencies of 4-8 peristaltic sequences per minute for periods of 2-8 min. The recurrent peristaltic sequences developed spontaneously during manometry and were associated with the onset of vague chest discomfort in four patients; one patient reported no symptoms during recurrent peristalsis. Duration and propagation velocity of the recurrent peristaltic contractions differed significantly from primary peristalsis in four patients. Recurrent autonomous esophageal peristalsis is an unusual motor pattern that may be associated with vague chest discomfort. The circuit(s) mediating recurrent autonomous peristalsis are unknown.
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ranking = 7.0494290275006
keywords = discomfort, chest
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