Long-term outcomes of gastric banding surgery 'poor'
Almost half of patients who underwent surgery for laparoscopic adjustable gastric banding (LAGB) had their bands removed and many experienced complications in the 12 or more years after the procedure, results from a small trial published in the Archives of Surgery indicate.
“The high failure rate of LAGB, at least in our hands, could be detrimental to its future continued widespread use as a restrictive weight loss operation,” wrote Jacque Himpens, MD, and colleagues from the department of gastrointestinal surgery at Saint Pierre University Hospital in Brussels, Belgium.
LAGB and Roux-en-Y gastric banding (LRYGB) are the two most common surgical techniques in what many believe is the only valid treatment for morbid obesity, according to background information in the study. But opponents of LAGB have expressed concerns that patients often regain weight, undergoing significant complications along the way that may result in a mediocre quality of life.
To determine whether this is the case, Himpens et al analyzed the long-term safety and efficacy of LAGB among 82 patients who underwent the procedure between Jan. 1, 1994 and Dec. 31, 1997. There were more women than men (74 vs. 8), and mean age was 50 years. At baseline, patients had a mean BMI of 41.57.
The researchers obtained data from hospital medical records, postoperative office visits, patient questionnaires, telephone interviews and in-office evaluations. They found that:
- Either major or minor complications occurred in 58.5% of patients, with 39% experiencing a major complication and 28% experiencing band erosion;
- Reoperation occurred in 59.8% of patients, either for complications, lack of weight loss, or regaining of weight;
- Band removal was necessary for 50% of patients, with 17.1% switched to LRYGB;
- Mean long-term mean excess weight loss was 42.8% overall, with an average decrease in BMI from 41.57 to 33.79;
- Among patients that did not have their band removed, mean excess weight loss was slightly higher at 48%.
Despite these findings, 60.3% of patients reported that they were satisfied with the procedure. Quality of life scores were comparable to the nonsurgical average, data indicated.
“Because nearly 1 out of 3 patients experience band erosion, and nearly 50% of patients required removal of their bands, LAGB appears to result in relatively poor long-term outcomes,” the researchers wrote.
They noted that more recent surgical techniques, such as “pars flaccida” and the use of wider softer bands, might produce better results than the “perigastric” techniques that were used at the time of initial surgery.
Clifford W. Deveny, MD, of the department of surgery at Oregon Health and Science University in Portland, agreed that the results of the study were not favorable for LAGB in an accompanying editorial. He pointed out that although data from previous studies indicate that LAGB is an easier operation to perform than LRYGB, complications are higher among patients who receive LAGB.
“The data in this study, as well as the experience in our own institutions, should influence our choice of procedure (LAGB or LRYGB) and the manner in which we inform our patients of the advantages and disadvantages of each procedure,” Deveny wrote.