Laparoscopic Adjustable Gastric Banding In 2000
Consecutive Obese Patients: 12-Year Results
Laparoscopic Adjustable Gastric Banding (LAGB) with the LAP-BAND is the most commonly performed surgical procedure for the treatment of morbid obesity in Europe, Australia and South America. Since FDA approval in 2001 the LAP-BAND has ranked second among all bariatric procedures performed in the U.S. and, to date, approximately 300,000 LAP-BAND procedures have been performed worldwide.
Background:
The purpose of this study was to examine 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years of follow up. LAGB is widely accepted but its efficacy in the long run is questioned since long term results with a high follow-up rate are not common.
Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean body weight 127.7+ –24 kg, mean body mass index (BMI) 46.2+ –7.7) underwent the LAP-BAND procedure. All operations were performed by ILOST surgeons, Dr. Franco Favretti and Dr. Gianni Segato, part of the multi-disciplinary team that developed the laparoscopic application of the LAP-BAND back in 1993.
Results:
The ILOST team of surgeons has performed the LAP-BAND procedure on more than 6.000 patients. Dr. Franco Favretti and Dr. Gianni Segato have just published the long term results (more than 12 years) of their own series of 2.000 patients. These results are unparalleled. There are no similar reports in the scientific
literature.
Results measured over 12 years included mortality, complications, weight loss and resolution/improvement of co-morbidities. Life expectancy was evaluated in an additional study of LAP-BAND vs. medical therapy. Patients were followed at 1, 3, 6, and 12 months post-operatively and yearly thereafter. Band adjustments were performed with barium swallow under fluoroscopy.
Zero surgical mortality in the entire series.
A mortality rate of 0 in 1,791 consecutive LAP-BAND patients attests to the benign nature of the LAP-BAND surgery.
Re-operation rate of less than 5%.
Major complications requiring re-operation occurred in 106 (5.9%) patients. These included stomach slippage + pouch dilatation in 70 (3.9%) patients (band removed in 20 patients–1.1%, repositioned in 50 patients–2.8%), erosion in 16 (0.9%) patients (band removed), psychological intolerance in 14 (0.7%) patients (band removed), miscellaneous (HIV, infection, mircroperforation) in 5 (0.27%) patients (band removed) and gastric necrosis in 1 (0.05%) patient (gastrectomy performed). If we exclude the 31 major complications of the learning curve period (first 100 patients), the complication rate is reduced to 4.4%.
Unprecedented 12-year follow-up rate of 91% allowed ILOST surgeons to report reliable data.
Most common co-morbidities were hypertension (35.6%), osteoarthritis (57.8%), diabetes (22%), dislipidemia (27.1%), sleep apnea (31.4%), depression (21.2%), hyperuricemia (27.1%), gallstones (8.7%) irregular menstrual cycle (4.9%), heart failure (1.4%), sweet eating (22.5%) and binge eating (18.5%).
Average weight loss in the entire series of 1,791 patients.
Weight loss (kg, BMI, %EWL) for the entire series is represented in Figure 1. At 10 years the average weight was 101.4 ± 27.1 kg (loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5 points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ≤ 49) and super-obese (BMI ≥ 50) were separated into two groups for evaluation/comparison and weight loss in terms of kg and BMI in Figure 2. At 10 years the weight of the morbidly obese group was 94.6 ± 18.0 kg and was 123.2 ± 38.5 kg in the super-obese group, indicating weight losses of 23.8 kg and 29.6 kg, respectively.
Results of the case/control study showed increased life expectancy after LAP-BAND as compared with medical treatment alone.
The 5-year survival in the LAP-BAND-treated group and in the medically-treated group is shown in Figure 3, where a statistically significant difference in survival can be clearly seen in favor of the surgically-treated group with a 60 % reduction in total mortality.
Conclusions:
It comes as no surprise that gastric banding is the most commonly performed bariatric surgery in the world. As our data indicate, the LAP-BAND Adjustable Gastric Banding procedure is safe and effective for the treatment of both morbidly obese and super-obese patients. In experienced hands the complication rate is low and significant, stable weight loss out to at least 12 years can be the norm.
The LAP-BAND’s adjustability feature allows patients to continue losing weight and to maintain lost weight over time. Of course, intensive follow-up and regular stoma adjustments must be a strictly enforced part of the process as they are integral to the patients’ success.
The LAP-BAND procedure has been and will remain our first-choice bariatric operation.
To read the full article (PDF file) of “Laparoscopic Adjustable Gastric Banding In 2000 Consecutive Obese Patients: 12-Year Results” published in Obesity Surgery Journal February 2007 issue, please click here.