Seminars in Pediatric Surgery 23 (2014) 17–20

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Seminars in Pediatric Surgery

journal homepage: www.elsevier.com/locate/sempedsurg

Laparoscopic adjustable gastric banding in adolescents

Jeffrey L. Zitsman, MD
Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, New York, New York 10032

a r t i c l e in fo a b s t r a c t

Gastric band placement developed as a means of limiting the amount of solid food that enters the
Keywords: stomach, relying on the principle of reducing caloric intake by reducing food volume. By making it
Adolescent obesity surgery difficult for a patient to swallow a large bite of food, one ideally could learn to change eating behavior to
Adolescent gastric band take smaller bites and eat more slowly in order to avoid the unpleasant sensation of food backing up at
the level of the restriction. Limiting intake should result in weight loss. This article reviews the history of
gastric band surgery, the operation and follow-up care, complications associated with gastric banding,
and results to date.
& 2014 Elsevier Inc. All rights reserved.

Introduction
Obesity has emerged as one of the most serious health issues
worldwide.1 Over the past several decades, all age groups have
experienced an increase in the number of overweight and obese
individuals.2 Obesity has a negative impact on health and well-
being over time; children and adolescents who develop severe
obesity are highly likely to continue to be obese as adults and may
well suffer from weight-related co-morbid conditions such as type
II diabetes mellitus, obstructive sleep apnea, hypertension, and
other metabolic disorders.3
Weight loss in an individual with obesity requires a change in
eating behavior. Weight management is a multibillion dollar
industry and includes commercial weight loss programs, dietary
supplements, gym programs, and for some, surgery. Few people
whose body mass index (BMI) is higher than 40 kg/m2 can lose
weight successfully with diet and exercise alone.
Weight loss surgery (WLS) helps patients change their eating
behavior. All procedures incorporate reduction in food intake,
some by limiting access to the stomach and others by surgically
reducing the size of the stomach pouch. The guiding principle is to
limit the number of calories an individual can ingest to force the
body to turn to its large supply of excess calories stored as fat for
energy. Gastric banding restricts entry of solid and semi-solid food
into the stomach with the purpose of achieving that goal.
History
The initial use of a tie or a band was to reinforce the narrowed
portion of the gastric lesser curvature that would receive food,
E-mail address: jlz2@columbia.edu
thus excluding the majority of fundus and limiting gastric capacity.
These procedures, termed banded gastroplasties, were first
reported in the early 1980s. Mason's technique featured the
creation of a window in the gastric fundus through which he
passed a polypropylene mesh collar around the narrowed lesser
curvature channel.4 He stressed limited band size and carefully
measuring pouch volume under pressure to minimize band
erosion from too tight a band and to prevent inadequate weight
loss from leaving too large a pouch. Gastric banding without
stapling was introduced in Scandinavia.5,6 Early results showed
good weight loss in the 6 months following surgery, then a
plateau.7,8 Among the earliest reports of results using a gastric
band that had been modified to allow for adjustments are Arata
and Perry9 and Kuzmak.10 In each case the surgical complication
rate was lower than with previous procedures. Kuzmak reported
average excess weight loss of 60% and 64% in patients who had
undergone conversion to adjustable gastric banding and primary
gastric band surgery, respectively, at 4 years following surgery.
Peri-operative complications included pulmonary embolism, gas-
tric fistula, evisceration, intrabdominal abscess, pouch perforation,
and incorrect band tightening, occurring in one patient in each
instance.
Laparoscopic placement of a gastric band (LAGB) was first
reported by Catona et al.11 in 1992. Morino et al.12 described their
technique for laparoscopic gastric band placement in 1994. The
following year Favetti et al.13 reported a series of 30 patients who
had undergone LAGB successfully. Follow-up was limited, but
4 patients who had reached 12 months post-operatively were
reported to average 70.6% EWL. Enthusiasm for the procedure was
reflected in the burst of publications from countries around the
world.14–27 In the US a multicenter trial was initiated in 1995 to
evaluate LAGB in patients 18 and older prior to FDA approval. In
December 2000, the FDA recommended approval with clear
guidelines for long-term follow-up. De Maria et al.28 reported less

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18 J.L. Zitsman / Seminars in Pediatric Surgery 23 (2014) 17–20
satisfactory weight loss and higher esophageal dilation rate than in
reported experience outside of the US. With LAGB approved for
use in adults in the US in 2001, however, additional surgeons
reported better results, benefitting from the growing experience as
more patients selected the procedure over Roux-en-Y gastric
bypass (RYGBP).29,30 In 2003, 5-year follow-up results of the
Swedish Obesity Study were presented.31 This study used a some-
what different device than many of the other investigators but
reported very good results with mean excess weight loss of 30%,
41%, 49%, 55%, and 57% and post-op years 1 through 5, respectively.
Over 80% of their subjects achieved excess weight loss 4 50%.
Although adolescents had been included in numerous large
published series of LAGB results, the first report of LAGB used as a
weight loss procedure in adolescents appeared in 2003. Dolan
et al.32 reported their experience with 17 youths (aged 12–19 years)
with a mean BMI of 44.7 kg/m2 (range 31.6–70.5) with follow-up of
12–46 months following LAGB. Two complications occurred: one
leaking port and one band slip, both of which required surgical
intervention. Over 80% of their patients lost 450% of their excess
weight by 24 months, suggesting that adolescents would have
results similar to those in adults. The authors concluded that LAGB
“is a safe and effective method of weight loss for obese adolescents”
in short- and medium-length follow-up. Dolan and Fielding com-
pared that group to 17 adults in their series who had also under-
gone LAGB. The groups were matched for sex and BMI. The excess
weight loss in adolescents and adults was 69.3% and 52.8%,
respectively, at 2 years, and BMI fell from 42.2 kg/m2 to 30.2 kg/m2
in adolescents and from 41.8 kg/m2 to 33.1 kg/m2 in adults.
Horgan et al.33 reported the first group of adolescents to
undergo LAGB from the United States in 2005. Four patients aged
17–19 years underwent LAGB after failure to lose weight with
dietary management and exercise monitoring under a protocol
approved by the US Food and Drug Administration (FDA). Follow-
up ranged from 4 to 30 months. All patients had BMI Z 40 kg/m2
and all patients showed loss of excess weight (range 17–87%). They
stated that LAGB could be performed safely in adolescents and
could emerge as a surgical option in a comprehensive weight loss
program. Angrisani et al.34 published his experience with LAGB in
Italian adolescents with obesity in 2005, and Silberhumer et al.35
reported his results of adolescents undergoing LAGB in Austria in
2006. Additional papers appeared from Australia,36 Israel,37 New
York,38 and Saudi Arabia.39 Holterman et al.40,41 and Nadler et al.42
updated their reports with additional length of follow-up; Nadler
et al.43 subsequently reported that weight loss following LAGB was
associated with improvement and resolution of metabolic comor-
bidities and excess fat.
O'Brien et al.44 reported the first prospective randomized trial
comparing intensive medical management (e.g., diet and exercise)
and weight loss surgery (LAGB) in a group of Australian adoles-
cents with severe obesity. Over a 2-year period, 25 individuals
aged 14–18 years in each group were followed up for weight loss,
changes in comorbidities, and conversion. Adolescents who under-
went LAGB lost significantly more weight than those in the
medical intervention group (34.6 kg vs 3.0 kg), showed better
improvement in BMI z score (from 2.39 to 1.32 vs 2.41 to 2.26),
and resolution of metabolic syndrome (9/9 in the LAGB group vs
4/10 in the medical treatment group, p ¼ 0.008). One-third of the
patients who underwent LAGB required revisional procedures for
pouch dilation or tubing dysfunction. Twenty-four of 25 individ-
uals enrolled in the LAGB arm completed the study as compared to
18 of 25 in the medically managed group. In the latter, 4 patients
withdrew due to failure to lose weight; 1 cited family problems,
and 1 was unable to attend follow-up visits. One patient in each
group refused to return. The authors state that while LAGB surgery
is not a “quick fix,” patients can lose weight safely and effectively
in a surgical weight loss program.
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Technique
A variety of techniques have been described to carry out LAGB;
most surgeons follow the approach described by Ren and Field-
ing.45 There is no difference between adolescent and adult
technique since the procedure is designed to address patient size
and not age. Patients void prior to entering the operating room.
An inflatable transfer device is in place on the OR table to facilitate
patient transfer at the end of the procedure. Patients move
themselves to the OR table and general endotracheal anesthesia
is induced. Sequential venous compression stockings are used in
all cases. A padded foot plate is fastened to the end of the table and
the patient is secured to the table with 2 straps. Bladder catheters
are not inserted. Prophylactic antibiotics (cefazolin; clindamycin
for patients with penicillin allergy) are given and 5000 U of
heparin are given subcutaneously. The abdomen is prepped and
draped. A small hole is made in the drape to accommodate the
Nathanson retractor where it is to be attached to the table. A
5-mm port is placed in the left upper quadrant (we use a clear
optical port) and abdominal pressure is raised to 15 mmHg. The
table is then placed in steep reverse Trendelenburg position.
A second 5-mm port is placed in the right midclavicular line in a
mirror image position. We then insert the Nathanson retractor
blade through a small incision to the left of the xyphoid and
corresponding to the edge of the left lobe of the liver. We elevate
the left hepatic lobe to expose the esophagogastric area. A trans-
verse incision is then made to accommodate the injection port. We
place the incision just to the right of the midline approximately 1/3
of the distance between the umbilicus and the xyphoid, and we
insert a non-cutting 15-mm port through this site, entering the
abdomen just left of midline. A third 5-mm port is placed in the
left anterior axillary line at the same level of the other 5-mm ports.
The fat and adventitial tissue at the gastroesophageal junction
is opened with cautery, and using blunt dissection, we expose the
left crus of the diaphragm. Attention is then turned to the lesser
omentum. The pars flaccida is opened with cautery. A small
opening is made in the fat immediately anterior to the right crus.
With blunt dissection we make a narrow tunnel behind the
stomach aiming to emerge on the left side immediately anterior
to the crus just superior to the upper pole of the spleen. We
inspect the esophageal hiatus carefully and repair any hernia
noted. Through the 15-mm port, we introduce the band; we use
the LapBands System (Allergan, Inc; Irvine, CA) and select
AP-Standard size band in most cases, reserving the AP-Large band
for patients with bulky, thick stomachs. The tubing is fed through
this tunnel, threaded into the appropriate opening on the band
and locked into place. This creates a small upper gastric pouch.
Care must be taken not to place the band too far down around the
stomach as this will result in obstruction. In most cases we sutured
the anterior gastric fundus over the band, securing it to more
proximal tissue at the cardia and uppermost fundus; however this
did not eliminate gastric prolapse and its value has subsequently
been challenged. In our most recent cases, we eliminated pexing
the fundus over the band but placed a non-absorbable suture
through the anterior fundus wall and fixed the stomach to the
original left upper quadrant port site. The end of the tubing is
brought through the 15-mm port and attached to the injection
port, which is then secured to the anterior rectus fascia. The
Nathanson retractor is removed and the 15-mm port site hole is
closed at the fascial level using a suture-passing device. Once
closure is confirmed, the remaining ports are removed and all
wounds are closed. Small amounts of clear fluids are begun when
the patients have recovered from anesthesia. In our center patients
are kept overnight for observation. We obtain an upright abdomi-
nal radiograph prior to discharge; this provides baseline positions
of the band and the port, which can be helpful should later
 J.L. Zitsman / Seminars in Pediatric Surgery 23 (2014) 17–20
problems arise. Each patient is instructed to begin a puree diet
several days after discharge. In 2008 Nguyen et al.46 reported
successful adaptation of single-incision adjustable gastric banding
as a technique for the procedure.
Band management
Band adjustments begin at 6 weeks, allowing the port site
wound a chance to heal before it is manipulated. We perform
adjustments using a 22-gauge 1.5 needle with a Huber tip. Most
adjustments are made in the office without fluoroscopy. The initial
fill is 3 ml for the smaller band and 4 ml for the larger. All patients
are advised to take liquids only for 24 h, puree for next 24 h, and
then may return to a solid diet. A subsequent fill (2 ml and 3 ml
according to band size) is offered 4 weeks later. Additional fills if
necessary are offered at 1-month intervals, and fluid removal is
carried out upon request. In those patients whose ports are
difficult to access, the procedure is performed using fluoroscopy;
often the scout image shows a shift in port orientation indicating a
need for re-operation. Goal rate of weight loss is 1–1.5 lb/week.
Patients are followed up monthly after surgery until stable weight
loss is achieved, after which patients are seen at 6–12 month
intervals. Diet and exercise assessment and guidance is carried out
at each visit. As patients grow into adulthood we help them
connect to an adult weight loss surgery program for ongoing
evaluation and care.
Results
Patient outcomes from selected adolescent LAGB reports are
presented in Table 1. In general the adolescent outcomes are
similar to those reported in adults, with weight loss and corre-
sponding improvement in health in 12–24 months of follow-up.
Health benefit of LAGB is less clear for many patients as time
passes. Obese individuals who lose weight often correct or show
improvement in obesity-related co-morbid conditions. Early
enthusiasm for LAGB in adults has been dampened by weight loss
plateau, weight regain, and late complications of surgery that have
required re-operation with band removal and in some cases,
conversion to other weight loss procedures.47
In adult series comparing LAGB to other weight loss proce-
dures, patients initially experience weight loss with LAGB but do
not generally match the weight loss achieved with RYGBP or with
VSG. Lee et al.49 recently reported superior weight loss outcomes
and resolution of co-morbid conditions in a group of adolescents
who underwent LRYGB compared to a similar cohort of obese
adolescents who underwent LAGB. Lennerz et al.50 have reported
safety and effectiveness of LAGB, LRYGB, and VSG is a group of 345
obese adolescents and young adults selected from hospitals in
Germany. They found that their patients had similar weight loss
Table 1
Selected reports of LAGB in adolescents.
Study n Age at surgery
(yr)
32
Dolan et al. 17 12–19
Abu-Abeid and Szold23 11 11–17
Angrisani et al.34 58 15–19
Fielding and Duncombe36 41 12–19
Nadler et al.42 73 13–17
Holterman et al.41 20 14–17
Zitsman et al.48 137 14–19
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19
results to adults reported in the literature, and that weight loss
and BMI reduction was significantly less with LAGB (  28 kg;
 9.5 kg/m2) when compared to LRYGB (  50 kg;  16.4 kg/m2)
or VSG (  46 kg;  15.4 kg/m2), (p o 0.001).
Complications
Surgical complications of LAGB in adolescents are rare, but
various types have been reported (Table 2). Among those, peri-
operative adverse events in the author's experience are band
malpositioning, laparoscopic port site bleeding, incisional pain,
and prolonged ileus. Gastric injury, wound infection, and deep
venous thrombosis have also been reported. Injuries to the
injection port and the access tubing during adjustment have
occurred and require re-operation.
Emesis and food intolerance are common, occurring in 4 50%
of patients in our series. Most patients admit to eating too quickly
or not paying attention to the amounts they are taking in when
emesis occurs. In each case patients can change their eating
pattern to eliminate this cause. Nearly 90% of patients identify at
least one food item that is very difficult for them to swallow:
bread, rice, and dry chicken are the most common ones named.
Avoiding these foods eliminates this problem.
Long-term complications have been noted in adults and as
more adolescents are being followed longer, they, too, are increas-
ingly noted to be having complications. Band slippage and gastric
prolapse have been reported, as have gastric erosion and port
displacement. Esophageal dilation has been diagnosed, as has
symptomatic esophageal reflux. Chronic left upper quadrant pain
has been reported. Acute cholecystitis has been noted following
weight loss. One patient in the author's series developed a small
bowel obstruction with volvulus around the connecting tubing;
the bowel was viable and the system was reconstituted (at the
patient's request). Additionally, some patients fail to lose weight
after LAGB, and the device is removed to prepare for additional
surgery.
Summary
Laparoscopic adjustable gastric banding became an acceptable
weight loss procedure for obese adults worldwide. Its early
effectiveness, the safety of placement, and the potential to remove
the device made it attractive for use in adolescents with obesity.
The device has been an effective weight loss tool for many adults
and adolescents. In the United States, LAGB use has been limited to
those few centers approved by the FDA to implant bands in clinical
trials and to programs willing to perform LAGB for “off label”
indications, i.e., in morbidly obese patients o 18 years. Early
results were promising; longer-term results suggest that adoles-
cents are likely to have results very similar to adults. Results from
Mean pre-op BMI Mean BMI post-op Mean follow-up years Comorbidities
(kg/m2) (kg/m2) (range)
Resolved/improved
44.7 30.2 2 (1–4) R
46.6 32.1 2 R/I
46.1 35.9–29.7 1–7 R
42.4 29 2.7 R
48 32.1 2 R
50 7 10 ↓ 9.4 1.5 (1.25–3.25) R
48.2 39.3 3 (2–5) R/I
20 J.L. Zitsman / Seminars in Pediatric Surgery 23 (2014) 17–20
Table 2
Adverse events related to LAGB surgery.
Associated with LAGB
Post-op bleeding
Prolonged ileus
Port flip
Port leak
Prolapse
Band slip
Bowel obstruction
Esophagitis (bleeding)
Band erosion
Port site hernia
Pain
Associated with weight loss
Cholecystitis
Alopecia
Excess skin
Dehydration
an industry-sponsored trial of LAGB should become available and
will provide useful information for the FDA to decide whether to
extend indications for LAGB to adolescents. The challenge remains
to identify the patient—adolescent or adult—who will be among
those who lose weight successfully following LAGB.
References
1. Deckelbaum RJ, Williams CL. Childhood obesity: the health issue. Obes Res.
2001;9(Suppl 4):239S–243S.
2. Cynthia L Ogden, Carroll Margaret D. Prevalence of overweight, obesity, and
extreme obesity among adults: United States, Trends 1960–1962 through
2007–2008. Available at http://www.cdc.gov/nchs/data/hestat/obesity_adult_
07_08/obesity_adult_07_08.pdf.
3. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into
adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–488.
4. Mason EE. Vertical banded gastroplasty. Arch Surg. 1982;117(5):701–706.
5. Bo O, Modalsli O. Gastric banding, a surgical method of treating morbid obesity:
preliminary report. Int J Obes. 1983;7(5):493–499.
6. Solhaug JH. Gastric banding: a new method in the treatment of morbid obesity.
Curr Surg. 1983;40(6):424–428.
7. Løvig T, Haffner JF, Nygaard K, Stadaas JO. Gastric banding for morbid obesity:
early results. Int J Obes. 1987;11(4):377–384.
8. Sjøberg EJ, Andersen E, Hoel R, Reinertsen S, Søreide O. Gastric banding in the
treatment of morbid obesity. Factors influencing immediate and long-term
results. Acta Chir Scand. 1989;155(1):31–34.
9. Arata JE, Perry AJ. Adjustable gastric banding. Obes Surg. 1991;1(1):103–104.
10. Kuzmak LI. A review of seven years' experience with silicone gastric banding.
Obes Surg. 1991;1(4):403–408.
11. Catona A, Gossenberg M, La Manna A, Mussini G. Laparoscopic gastric banding:
preliminary series. Obes Surg. 1993;3(2):207–209.
12. Morino M, Toppino M, Garrone C, Morino F. Laparoscopic adjustable silicone
gastric banding for the treatment of morbid obesity. Br J Surg. 1994;81(8):
1169–1170.
13. Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric
banding: technique and results. Obes Surg. 1995;5(4):364–371.
14. Paganini AM, Guerrieri M, Feliciotti F, Lezoche E. Laparoscopic adjustable
silicone gastric banding (LASGB) for the treatment of morbid obesity. Surg
Technol Int. 1996;5:147–150.
15. Ashy AA, Gareer WY, Omayer AS, Meccawy AA. Laparoscopic adjustable silicone
gastric banding in the treatment of super obesity in the Jeddah area, Saudi
Arabia. A preliminary report. Int Surg. 1996;81(3):289–291.
16. Fried M, Peskova M, Kasalicky M. Assessment of the outcome of laparoscopic
nonadjustable gastric banding and stoma adjustable gastric banding: surgeon's
and patient's view. Obes Surg. 1998;8(1):45–48.
17. Belachew M, Legrand M, Vincent V, Lismonde M, Le Docte N, Deschamps V.
Laparoscopic adjustable gastric banding. World J Surg. 1998;22(9):955–963.
18. Bakr AA, Fahim T. Laparoscopic adjustable gastric banding is a safe and effective
treatment for morbid obesity. JSLS. 1998;2(1):57–61.
19. O'Brien PE, Brown WA, Smith A, McMurrick PJ, Stephens M. Prospective study of
a laparoscopically placed, adjustable gastric band in the treatment of morbid
obesity. Br J Surg. 1999;86(1):113–118.
20. Yashkov YI, Kuzin NM, Sedletsky YI. Obesity surgery in Russia. Obes Surg.
1999;9(1):40–43.
Downloaded for Anonymous User (n/a) at Sapthagiri Institute of Medical Sciences and Research Centre from ClinicalKey.com by Elsevier on December 02, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
21. Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid
obesity. J Laparoendosc Adv Surg Tech A. 1999;9(1):23–30.
22. Miller K, Hell E. Laparoscopic adjustable gastric banding: a prospective 4-year
follow-up study. Obes Surg. 1999;9(2):183–187.
23. Abu-Abeid S, Szold A. Results and complications of laparoscopic adjustable
gastric banding: an early and intermediate experience. Obes Surg. 1999;9(2):
188–190.
24. Silva AS, Cardoso H, Nogueira C, Santos J, Vilaça H. Treatment of morbid obesity
with adjustable gastric band: preliminary report. Obes Surg. 1999;9(2):194–197.
25. Holéczy P, Payer J J Jr, Králová A. Laparoscopic adjustable gastric band: first
experience in Slovakia. Obes Surg. 1999;9(2):198–201.
26. Dargent J. Laparoscopic adjustable gastric banding: lessons from the first 500
patients in a single institution. Obes Surg. 1999;9(5):446–452.
27. Victorzon M, Tolonen P. Laparoscopic silicone adjustable gastric band: initial
experience in Finland. Obes Surg. 2000;10(4):369–371.
28. De Maria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic
adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg.
2001;233(6):809–818.
29. Rubenstein RB. Laparoscopic adjustable gastric banding at a U.S. center with up
to 3-year follow-up. Obes Surg. 2002;12(3):380–384.
30. Ren CJ, Horgan S, Ponce J. US experience with the LAP-BAND system. Am J Surg.
2002;184(6B):46S–50S.
31. Steffen R, Biertho L, Ricklin T, Piec G, Horber FF. Laparoscopic Swedish
adjustable gastric banding: a five-year prospective study. Obes Surg. 2003;
13(3):404–411.
32. Dolan K, Creighton L, Hopkins G, Fielding G. Laparoscopic gastric banding in
morbidly obese adolescents. Obes Surg. 2003;13(1):101–104.
33. Horgan S, Holterman MJ, Jacobsen GR, et al. Laparoscopic adjustable gastric
banding for the treatment of adolescent morbid obesity in the United States:
a safe alternative to gastric bypass. J Pediatr Surg. 2005;40(1):86–90 [discussion
90-1].
34. Angrisani L, Favretti F, Furbetta F, et al. Obese teenagers treated by lap-band
system: the Italian experience. Surgery. 2005;138(5):877–881.
35. Silberhumer GR, Miller K, Kriwanek S, Widhalm K, Pump A, Prager G.
Laparoscopic adjustable gastric banding in adolescents: the Austrian experi-
ence. Obes Surg. 2006;16(8):1062–1067.
36. Fielding GA, Duncombe JE. Laparoscopic adjustable gastric banding in severely
obese adolescents. Surg Obes Relat Dis. 2005;1(4):399–405 [discussion 405-7].
37. Yitzhak A, Mizrahi S, Avinoach E. Laparoscopic gastric banding in adolescents.
Obes Surg. 2006;16(10):1318–1322.
38. Nadler EP, Youn HA, Ginsburg HB, Ren CJ, Fielding GA. Short-term results in 53
US obese pediatric patients treated with laparoscopic adjustable gastric
banding. J Pediatr Surg. 2007;42(1):137–141 [discussion 141-2].
39. Al-Qahtani AR. Laparoscopic adjustable gastric banding in adolescent: safety
and efficacy. J Pediatr Surg. 2007;42(5):894–897.
40. Holterman AX, Browne A, Dillard BE BE 3rd, et al. Short-term outcome in the
first 10 morbidly obese adolescent patients in the FDA-approved trial for
laparoscopic adjustable gastric banding. J Pediatr Gastroenterol Nutr. 2007;
45(4):465–473.
41. Holterman AX, Browne A, Tussing L, et al. A prospective trial for laparoscopic
adjustable gastric banding in morbidly obese adolescents: an interim report
of weight loss, metabolic and quality of life outcomes. J Pediatr Surg. 2010;
45(1):74–78, http://dx.doi.org/10.1016/j.jpedsurg.2009.10.013 [discussion 78-9].
42. Nadler EP, Youn HA, Ren CJ, Fielding GA. An update on 73 US obese pediatric
patients treated with laparoscopic adjustable gastric banding: comorbidity
resolution and compliance data. J Pediatr Surg. 2008;43(1):141–146.
43. Nadler EP, Reddy S, Isenalumhe A, et al. Laparoscopic adjustable gastric
banding for morbidly obese adolescents affects android fat loss, resolution of
comorbidities, and improved metabolic status. J Am Coll Surg. 2009;209(5):
638–644.
44. O'Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding
in severely obese adolescents: a randomized trial. J Am Med Assoc. 2010;303
(6):519–526.
45. Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical techni-
que. J Laparoendosc Adv Surg Tech A. 2003;13(4):257–263.
46. Nguyen NT, Hinojosa MW, Smith BR, Reavis KM. Single laparoscopic incision
transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally
invasive surgical approach. Obes Surg. 2008;18(12):1628–1631.
47. Himpens J, Cadière GB, Bazi M, Vouche M, Cadière B, Dapri G. Long-term
outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146
(7):802–807.
48. Zitsman JL, DiGiorgi MF, I Fennoy et al. Adolescent laparoscopic adjustable
gastric banding (LAGB): prospective results in 137 patients. Journal of Pediatric
Surgery, in review.
49. Lee DY, Guend H, Park K, et al. Outcomes of laparoscopic Roux-en-Y gastric
bypass versus laparoscopic adjustable gastric banding in adolescents. Obes
Surg. 2012;22(12):1859–1864.
50. Lennerz BS, Wabitsch M, Lippert H, et al. Bariatric surgery in adolescents and
young adults safety and effectiveness in a cohort of 345 patients. Int J Obes
(Lond). 2013 [Epub ahead of print].