Laparoscopic adjustable gastric banding after the very low-calorie diet: Is it easier

Background: Laparoscopic adjustable gastric banding (LAGB) is a bariatric surgical procedure that is worldwide accepted. However, it can be very difficult in super obese patients with body mass index (BMI) > 50. Much interest has been paid recently in performing the LAGB operation after an initial programmed weight loss with the use of the very low-calorie diet (VLCD). Aims: We sought to analyze the impact of the VLCD on the technical difficulties during the LAGB. Settings and Design: Randomized controlled trial. Materials and Methods: We evaluated prospectively, the technical difficulties for a single, dedicated bariatric surgeon during the LAGB in two groups of patients - patients operated on after 6 weeks on a VLCD diet (Group A, n = 5) and patients on no diet (Group B, n = 5). The two groups had similar BMI during the operation. The technical difficulties for five-key steps during the LAGB were graded by three individuals who were blinded with regard to the patient group. (1 = first surgeon, 2 = second surgeon, 3 = observer). Statistical methods: Cumulative values for each step and BMI level in the two groups were analyzed by the Wilcoxon signed rank test. Results: All three independent observers\u2032 grading of technical difficulties were found lower in Group A (P < 0.05) overall, as well as for each BMI value. Conclusion: Preoperative weight reduction with the VLCD made the LAGB technically easier in Group A