P Tolonen

Vaasa Central Hospital, Vaasa, Province of Western Finland, Finland

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Publications (16)38.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The long-term efficacy of laparoscopic Roux-en-Y gastric bypass (RYGB) in the treatment of morbid obesity has been demonstrated. Laparoscopic sleeve gastrectomy (SG) as a single procedure has shown promising short-term results, but the long-term efficacy of SG has not yet been demonstrated. The aim of this study was to determine the preliminary 30-day morbidity and mortality of RYGB and SG in a prospective multicenter randomized setting. A total of 240 morbidly obese (BMI = 35-66 kg/m²) patients evaluated by a multidisciplinary team were randomized to undergo either RYGB or SG. There were 117 patients in the RYGB group and 121 in the SG group; two patients had to be excluded after randomization. Both study groups were comparable regarding age, gender, BMI, and comorbidities. There was no 30-day mortality. The median operating time was significantly shorter in the SG group (66 min vs. 94 min, p < 0.001). All complications were recorded thoroughly. There were 7 (5.8 %) major complications following SG and 11 (9.4 %) after RYGB (p = 0.292). Nine (7.4 %) SG patients and 20 (17.1 %) RYGB patients had minor complications (p = 0.023). The overall morbidity was 13.2 % after SG and 26.5 % after RYGB (p = 0.010). There were three (2.5 %) early reoperations after SG and four (3.3 %) after RYGB (p = 0.719). At 30-day analysis SG is associated with a shorter operating time and fewer early minor complications compared to RYGB. There were no significant differences in major complications or early reoperations. Long-term follow-up is required to determine the effect on weight loss, resolution of obesity-related comorbidities, and improvement of quality of life.
    Surgical Endoscopy 04/2012; 26(9):2521-6. · 3.43 Impact Factor
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    ABSTRACT: Background and Aims: We report the results for the first consecutive 360 Roux-en-Y gastric by-pass (RYGB) operations performed in a district hospital in Finland.Material and Methods: Demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients.Results: We performed 325 primary laparoscopic Roux-en-Y gastric bypass (LRYGB) opera-tions, one open RYGB, and 34 revisions. Mean BMI before the operations was 47.5 ± 7.8 kg/m2 (31.5-91.0 kg/m2). The percentage of patients with type 2 diabetes mellitus (T2DM) was high; 52.3% (170 patients). The mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 opera-tions (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. Overall morbidity averaged 19.1% (62/325). Severe complications were detected in 15 patients (4.6%). There was a tendency to more serious complications in the first group of patients. There was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months T2DM had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (WL) and excess weight loss (EWL) averaged 20% and 46% respectively.Conclusions: Operative time and postoperative hospital stay decrease significantly with in-creasing experience. The first one hundred patients may be at higher risk for complications. LRYGB operations may have an important impact on the resolution of T2DM in the operated population.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 01/2012; 101(3):184-9. · 1.17 Impact Factor
  • M Victorzon, P Tolonen, H Sintonen
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    ABSTRACT: important outcome measurements in bariatric surgery include the improvement or resolvement of medical comorbid conditions caused by obesity, and the possible changes in quality of life. The health-related quality of life (HRQoL) among Finnish obese subjects awaiting bariatric surgery has not previously been compared to age- and gender-standardized general population. the HRQoL in 75 obese subjects waiting for bariatric surgery was assessed by the generic 15D instrument. The resulting 15D profile and single index score were compared to those of a sample of age- and gender-standardized general population (n = 4955). The patients were significantly worse off than the age- and gender-standardized general population on 11 of the 15 dimensions. The mean total 15D score among patients scheduled for bariatric surgery was 0.844 compared to 0.934 in the control group (P < 0.001). the Finnish patients awaiting bariatric surgery suffer from a very poor HRQoL compared with age- and gender-standardized general population.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 01/2010; 99(3):122-6. · 1.17 Impact Factor
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    S Giordano, P Tolonen, M Victorzon
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    ABSTRACT: there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience. from March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic by-pass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34-63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected. intra-operative complications occurred in 4 patients (13.3%) in Group 1, in 5 patients (12.2%) in Group 2. Re-operations occurred 3 times (10.0%) in Group 1, and 4 times (9.8%) in Group 2 due to anastomotic complications, bleeding and/or bowel obstruction. Major complications occurred in four patients in Group 1 (13.3%) and in seven patients in Group 2 (17.1%). There was a significant difference in the overall morbidity rate (major and minor complications), which was 56.7% in Group 1 and 34.1% in Group 2 (p = 0.05). Mean operative time in Group 1 was 135 minutes, and in Group 2 122 minutes. Mean hospital stay was significantly shorter in Group 2 (3.9 days) than in Group 1 (5.7 days, p = 0.04). learning to handle the technique when performing the gastrojejunostomy during laparoscopic gastric bypass surgery may be faster and easier by using the linear stapler. This may be important knowledge for centres considering starting LRYGB practice, although the surgeon factor needs to be taken in account. The results should be interpreted with caution because the confounding effect of one surge-on performing one type of operation while the other surgeon (is performing) the second type of operation could not be taken into account in this prospective non-randomized analysis.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 01/2010; 99(3):127-31. · 1.17 Impact Factor
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    ABSTRACT: Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up. Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60-132). EWL < 25% or major reoperation was considered as a failure. EWL > 50% was considered a success. Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21-44). Mean (range) preoperative weight was 130 kg (92-191). Mean (range) preoperative body mass index was 49.28 kg/m2 (35.01-66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years. Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.
    Obesity Surgery 04/2008; 18(3):251-5. · 3.10 Impact Factor
  • M Victorzon, P Tolonen, T Vuorialho
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    ABSTRACT: The authors report their 7-year experience with day-case laparoscopic cholecystectomy (LC) to determine its applicability, safety, and cost effectiveness. Of 920 consecutive patients who underwent elective LC over a 7-year period, 567 (62%) were scheduled for day-case surgery. The median age of the patients was 48 years (range, 16-74 years), and the male/female ratio was 148/419. The selection criteria required an American Society of Anesthesiologists (ASA) grade of 1 or 2, absence of morbid obesity, low risk of common bile duct stones, adult company at home, and residence within 100 km of the hospital. The LC procedure was performed using a standard four-cannula technique. Propofol-opiate-rocuron-sevoflurane anesthesia, prophylactic antiemetics, and preemptive analgesia were administered in all cases. The mean length of the operation was 56 +/- 18 min. There was no hospital mortality, and 7 (1.2%) of 567 patients required conversion to open cholecystectomy. Approximately 356 (63%) of the 567 patients were discharged home on the same day as the operation, whereas 211 patients (37%) were admitted overnight after the operation because of social reasons (13.7%), surgeon preference (15.2%), nausea and/or pain (15.2%), operation late in the afternoon (14.2%), or patient preference (41.7%). There were no serious complications. A total of 22 patients visited the emergency unit, and 7 patients required readmission, giving a readmission rate of 2%. The overall postoperative morbidity rate was 6% (n = 22), with morbidities including retained stones (n = 2), bile leakage (n = 1), and pneumonia (n = 1). The mean procedural cost to the hospital was 1,836 euros for day-case LC, as compared with 2,712 euros for an inpatient operation. For selected patients, day-case LC is feasible and safe, providing a substantial reduction in hospital costs.
    Surgical Endoscopy 02/2007; 21(1):70-3. · 3.43 Impact Factor
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    ABSTRACT: Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published. A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 +/- 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy. Total number of reflux episodes decreased from a mean value of 44.6 +/- 23.7 SD preoperatively to 22.9 +/- 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% +/- 6.2% to 3.5% +/- 3.7%, P=0.0009, and DeMeester score decreased from 38.5 +/- 24.9 to 18.6 +/- 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 +/- 5.46 to 38.4 +/- 6.45 (P<0.0001), excess weight from 60.0 kg +/- 18.58 kg, 44.9% +/- 6.56% to 38.4 kg +/- 20.27 kg, 28.4% +/- 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.
    Obesity Surgery 12/2006; 16(11):1469-74. · 3.10 Impact Factor
  • M Victorzon, P Tolonen, T Vuorialho
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    ABSTRACT: We launched a prospective study to assess the feasibility of day-case laparoscopic fundoplication for gastro-oesophageal reflux disease in March 2003. The specific aims were to assess safety, acceptability and patient satisfaction. The inclusion criteria were American Society of Anaesthesiologists grade I-II surgical risk, body mass index < 35, and adult company at home (less than 50 km travel) or at patient hotel (more than 50 km travel). Patients were informed about the surgical procedure, the expected postoperative course, and the possible postoperative problems and complications. Surgery was performed under general anaesthesia with proposal-infusion, fentanyl, rocuronium and sevoflurane with air + oxygen. All patients received parenteral propacetamol, NSAID, local anaesthetics and metoclopramide, as pre-emptive analgesia before awakening. A total 360 degree floppy Nissen fundoplication was performed in all patients. Twenty-eight patients were included. There was one conversion to open surgery. All the other patients were discharged as planned and there were no readmissions. No intra- or postoperative complications occurred. Postoperative pain, nausea, fatigue and dysphagia were moderate. At interview the morning following the operation three patients reported they would rather have stayed over night at the hospital. However, all patients were ready for a similar procedure as day-case surgery again, if offered. At follow-up 26/28 (< 92.9%) patients were satisfied with the day-case treatment, one patient had no preference. All patients would recommend this operation as day-case surgery for a family member or friend. Laparoscopic day-case surgery for gastro-oesophageal reflux disease appears to be safe and well tolerated by the patients.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2006; 95(3):162-5. · 1.17 Impact Factor
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    ABSTRACT: To critically assess the outcome of surgery for oesophageal carcinoma, with or without neoadjuvant chemoradiotherapy. Since April 1998 until August 2002 resectable oesophageal cancer patients referred to us have received multimodal treatment, consisting of two courses of fluorouracil, cisplatin and hydroxyurea and 2 x 20 Gy of radiotherapy followed by surgery. The outcome of this treatment was compared to the outcome of a historical group of oesophageal cancer patients, treated with surgery alone in the time period 1994 to 1998. The patients represent a consecutive series of 20 resectable oesophageal carcinomas, referred to us since 1994. Four patients (20%) were treated for squamocellular carcinoma, 16 (80%) patients for adenocarcinoma. Treatment related toxicity was low and there was no death attributable to the chemoradiotherapy. Postoperative hospital mortality (< 30 days) and morbidity rates were 10% and 50%, respectively. A complete pathological response (T0) occurred in two of the nine patients in the multimodal group (22%). Overall median survival was 11 months. Median survival among patients in the multimodal group was 14 months, as compared with 7 months in the group treated with surgery alone (P = 0.041). Despite low volume, outcome of surgery for oesophageal carcinoma was acceptable.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2004; 93(1):37-42. · 1.17 Impact Factor
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    ABSTRACT: Health-related quality of life (HRQoL) in Finnish morbidly obese individuals was compared with that of Finnish age norms and prospectively with the HRQoL and the disease-specific quality of life (QoL) at 12 months, and cross-sectionally at 28 months, following laparoscopic adjustable gastric banding, mainly with the Swedish band. The Moorehead-Ardelt questionnaire was used for disease-specific QoL assessments in 95 patients preoperatively, in 52 patients prospectively followed-up to 12 months, and cross-sectionally in 52 patients operated at a median of 28 months earlier. A generic 15-dimensional questionnaire was used for HRQoL-measurements in 75 patients preoperatively, and 34 patients have been followed-up to 12 months. HRQoL outcomes were compared cross-sectionally with the 52 patients operated at a median of 28 months earlier. Disease-specific QoL scores were significantly improved on all domains of the Moorehead-Ardelt questionnaire 12 months after surgical treatment, an improvement maintained at a median of 28 months follow-up. Significant improvements in generic HRQoL scores were seen on the dimensions mobility, respiratory function, sleep, the performance of usual acts, vitality and sexuality 12 months after surgery. Significant worsening was seen on the eating dimension. Of these dimensions, mobility and sleeping were not significantly improved at a median of 28 months follow-up, and scores on the eating dimension were not significantly worse compared with values obtained in the preoperative group. HRQoL single index score was significantly improved 12 months after surgery. This improvement did not correlate with the extent of weight loss. Disease-specific QoL was significantly improved at 12 months follow-up, an improvement that seems to have been maintained at a median of 28 months following operation. HRQol was significantly improved 12 months after the operation. There may be a decline in the improvements after that.
    Obesity Surgery 01/2004; 14(6):788-95. · 3.10 Impact Factor
  • Pekka Tolonen, Mikael Victorzon
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    ABSTRACT: Although weight loss is an important immediate outcome after gastric banding operations, quality of life (QOL) has been shown to be an equally important outcome measure. From 1996 to May 2002, 125 consecutive patients have been operated laparoscopically for morbid obesity at our institution with the Swedish Adjustable Gastric Band (SAGB). We compared the Moorehead-Ardelt QOL scores of the first 60 patients, operated at a median of 2 years earlier, with a group consisting of the following consecutive 65 patients, who answered the questionnaire preoperatively. The QOL scores among the operated patients were significantly better (P<0.0001, unpaired t-test) on all domains of the Moorehead-Ardelt questionnaire compared to those not yet operated. Laparoscopic banding with the SAGB has been a safe procedure, with satisfactory weight loss and significant improvement in QOL scores 2 years postoperatively.
    Obesity Surgery 07/2003; 13(3):424-6. · 3.10 Impact Factor
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    M Victorzon, P Tolonen
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    ABSTRACT: The symptomatic outcome of 135 consecutive patients operated laparoscopically for gastro-oesophageal reflux disease (GORD) by a minimal paraoesophageal dissection technique is reported. At a median (range) follow-up time of 25 months (6-82 months) we sent the patients a self-assessment questionnaire regarding symptomatic outcome of the operation. Median (range) operation time was 65 minutes (33-185 minutes). Per- and postoperative complications occurred in four patients (3%). There were no conversions and no mortality. The answering rate was 91%. Of all patients, 87% were free of reflux symptoms, 84% without any medication, 99% reported at least improvement, 90%-95% reported persistence of favourable outcome, 90% were satisfied, 91% scored the outcome as good or excellent, and 95% of the patients were ready to recommend the operation to family or friend. However, 31% reported dysphagia and 76% troublesome gas bloating, causing problems in 24% of the patients. No association between different outcome variables and crural repair could be shown. Laparoscopic fundoplication can be done in a simple and fast way, with minimal morbidity, short hospital stay and without compromising outcome. Nevertheless, the operation is seldom without some sequel for the patient.
    Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2003; 92(2):138-43. · 1.17 Impact Factor
  • Mikael Victorzon, Pekka Tolonen
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    ABSTRACT: Morbid obesity is a rapidly increasing health risk in most industrialized countries. Unfortunately, conservative treatment methods will fail in the long run in almost 100% of patients. Today, long-lasting success can only be achieved by operative treatments. Laparoscopic gastric banding has the general benefits of minimally invasive techniques is relatively easy to perform and can be reversed or changed to any other operation aiming at weight loss, if necessary. We report here our primary and intermediate outcome of Laparoscopic Adjustable Gastric Banding (LAGB). Since 1996-2001 we have treated 110 (87 women, 23 men) morbidly obese patients with the Swedish Adjustable Gastric Band (SAGB). Median age (range) of the patients was 42 years (21-64), and preoperative median body mass index (BMI, kg/m(2)) (range) was 44 (35-66). Most of the patients suffered from obesity related co-morbidities. At a median follow-up of 27 months, mean weight loss was 30 kg, mean excess weight loss (range) 52% (11-108%), and median (range) BMI 34 (24-46). Reoperations due to band slippage (3 patients), band erosion (2 patients), infection (1 patient), and leakage of the band or the filling system (5 patients) have been necessary in 11 (10%) patients so far. Median postoperative hospital stay (range) was 3 days (2-53). There was no mortality. Immediate postoperative morbidity was 9%. More than 50% of the patients had signs of mild erosive gastroesophageal reflux disease during routine endoscopic follow-up 3 years after the operation. Weight loss following LAGB is generally good and complications few, at least in the short term. However, technical problems with the band causes morbidity and reoperations in a number of patients. Despite this fact, we think the LAGB operation is the best 'first' operation in the treatment of morbid obesity, although long-term results are not yet available.
    Digestive Surgery 02/2002; 19(5):354-7; discussion 358. · 1.47 Impact Factor
  • M Victorzon, P Tolonen
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    ABSTRACT: The reporting on outcome following barlatric procedures should include changes in comorbid conditions and quality of life (QOL), in addition to weight loss. The Bariatric Analysis and Reporting Outcome System (BAROS) appears to provide the means to fulfill these requests. We have re-evaluated our previously published, initial results of laparoscopic adjustable gastric banding, using BAROS. Our first 60 consecutive patients were treated laparoscopically between the years 1996 and 1999, using the Swedish Adjustable Gastric Band (SAGB). After a minimum follow-up of > or = 17 months (median follow-up 28 months, range 17-61 months), a postal questionnaire concerning QOL, medical condition and excess weight loss (BAROS) was sent to the patients. In addition, the patients' opinion regarding the operation was evaluated as well as the extent that the band had caused the patients any of the more common side-effects. 87% of the patients returned the questionnaire properly answered. According to BAROS, the outcome was regarded as VERY GOOD in 12% of patients, GOOD in 38%, FAIR in 29% and FAILURE in 21%. Not one had an EXCELLENT outcome. 23% of the patients were disappointed with their operation. The incidence of band-related side-effects was high. Our results are comparable with other published series including the learning curve. In our opinion, BAROS should be widely adopted.
    Obesity Surgery 12/2001; 11(6):740-3. · 3.10 Impact Factor
  • M Victorzon, P Tolonen
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    ABSTRACT: The Swedish adjustable gastric band (SAGB) was introduced in 1985 and rapidly gained popularity. Today more than 21,000 gastric banding procedures have been performed in Europe. The reported results of gastric banding operations are mainly good, although the method is not without controversies and risks. We report here our initial experience with the SAGB. 60 patients (44 women, 16 men) were treated surgically for morbid obesity between the years 1996 and 1999, with SAGB. Median age of the patients was 44 years (range 21-64) and preoperative median Body Mass Index (BMI, kg/m(2)) was 45 (range 35-55). 3 patients were operated by an open approach, and the remaining 57 laparoscopically. Operative time was 62-206 minutes (median 97 minutes). Only one operation was converted to open approach (1.8%), due to extensive adhesions. No intraoperative complications occurred. At 1 year follow-up, mean weight loss was 30 kg, mean excess weight loss was 50%, and median BMI was 35. 4 patients have been reoperated so far (6.7%) due to slippage of the band (2 patients), infection of the band (1 patient), and leaking of the filling system (1 patient). Median postoperative hospital stay was 3 days (range 2-53). Mortality was 0%. Immediate postoperative morbidity-rate was 12% (7/60), although serious morbidity occurred in only 1 patient (1.7%). Laparoscopically placed adjustable gastric band is a good option for the morbidly obese patient.
    Obesity Surgery 09/2000; 10(4):369-71. · 3.10 Impact Factor
  • Mikael Victorzon, Pekka Tolonen
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    ABSTRACT: Many studies of short-term to mid-term outcomes after laparoscopic adjustable gastric banding (LAGB) have been published, but reliable long-term outcome reports with a minimum follow up ≥10 years in a sufficient number of included patients are still scarce. The objective of this study was to evaluate the long-term results after LAGB. Sixty consecutive patients (44 women, 16 men) were treated for morbid obesity by LAGB between 1996 and 1999. Median age of the patients at the time of operation was 45 years (range 21-64). Median preoperative body mass index (BMI, kg/m(2)) was 45 (range 35-55). All patients were asked to adhere to a strict follow-up program. Patients' BMI and percentage excess weight loss (%EWL) were calculated in the hospital's database for bariatric patients, and excess weight was taken as the weight in kilograms above the weight at BMI of 25 kg/m(2). Complete data on all 60 patients could be assessed; thus, the overall rate of follow-up was 100%. After a median (range) follow-up of 14.1 years (13.2-16.8 years), the mean BMI (SD) dropped from 45 (5) to 36 (6) kg/m(2), with a mean (SD) EWL of 49% (29). At 15 years of follow-up, 29 (48%) bands have been removed, and 38 (63%) reoperations have been performed in 29 (48%) patients. Almost 70% received further treatment for their morbid obesity after band removal. Of those patients with the band still in place at 14 years, 40% had more than 50% EWL and 20% had less than 25% EWL. There was no mortality related to the primary or revisional operations, but 2 patients died of unrelated causes. Mean %EWL after LAGB after more than 14 years was fairly good-49%. However, a reoperation rate of more than 60% in 48% of the patients and a band removal rate of almost 50% may indicate that LAGB cannot be recommended as a primary procedure to the general morbidly obese population.
    Surgery for Obesity and Related Diseases 9(5):753-757. · 4.12 Impact Factor