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Risk of Gastric Pouch Enlargement With Adjustable Gastric Banding in Premenopausal Women: Sex Hormones May Play a Role

Dixon, John B. MBBS, PhD*; Cobourn, Christopher S. MD

doi: 10.1097/SLA.0b013e3182504665
Original Articles

Objective: To examine the influence of age and gender on the development of proximal gastric pouch distension (PPD) after laparoscopic adjustable gastric banding (LAGB) surgery.

Background: PPD is the most common reason for revision with adjustable gastric banding surgery. Maintaining the anatomical integrity of bariatric surgery is a key to long-term success. It is therefore important to understand risk factors for complications.

Methods: We extracted details of 3000 consecutive individuals who underwent primary LAGB procedures at a single center between February 2005 and May 2011. Contemporaneous details of all complications were recorded in a database. The characteristics of those that subsequently required revision surgery for PPD were assessed and compared with those that did not.

Results: There were 132 cases for PPD requiring surgical intervention before September 2011. Incident PPD occurred in 5.1% and 1.3% of women and men, respectively. The mean age of those with PPD was 39.9 ± 9.25 compared with 43.9 ± 11.0 for those without it. The age and gender effects were independent, and the age effect was restricted to women. The adjusted odds ratios were 0.971 (95% CI [confidence interval], 0.954–0.986, P < 0.001) for age and 0.26 (95% CI, 0.12–0.56, P = 0.001) for male gender and younger women were more likely to have asymmetrical distension.

Conclusions: Younger women are at higher risk of PPD after LAGB surgery than men and women older than 50 years. Sex hormones may play a role in predisposing to gastric stretch after surgery. These findings may apply more broadly to the gastric “restrictive” component of other bariatric procedures.

In a consecutive series of 3000 patients followed after adjustable gastric banding surgery 132 required revisional surgery for proximal gastric pouch distension. The risk was greatest in younger women and lowest in men of any age and older women. Sex hormones may predispose to gastric stretching with bariatric surgery.

*Vascular & Hypertension Division—Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia

Surgical Weight Loss Centre, Mississauga, Ontario, Canada.

Reprints: John B. Dixon, MBBS, PhD, Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia. E-mail:

Disclosure: C.S.C. is the director of the surgical practice attended by the patient cohort described in this publication. J.B.D. acts as a consultant for Allergan Inc and Metagenics Inc and is on the Medical Advisory Board for Nestle Australia. He was previously a member of the Scientific Advisory Board and received research funding from Scientific Intake Inc. J.B.D. currently receives a research fellowship from the National Health and Medical Research Council of Australia and also receives research support from Allergan Inc. C.S.C.'s practice currently receives research support from Allergan Inc and has previously received speaker and consultancy fees from Allergan Inc.

© 2013 Lippincott Williams & Wilkins, Inc.