Is it possible to improve long-term results of laparoscopic adjustable gastric banding with appropriate patient selection?

Abstract

Introduction: The gastric band is still offered as a good bariatric option for highly motivated and carefully selected patients. The question is whether this faith is justified or not. Aim: To assess long-term clinical outcomes of patients who underwent laparoscopic adjustable gastric banding (LAGB) at a single bariatric center and to examine variables associated with patients' adherence to scheduled postoperative appointments. Material and methods: A retrospective review of patients who underwent LAGB between 2004 and 2009 was performed. The initial cohort included 167 patients. Data regarding sex, age, preoperative weight, hometown population and distance from the bariatric center, and gastric band volume were collected. Compliance was measured as the number of postoperative appointments. Clinical outcome was defined as percent excess weight loss (%EWL) at the end of the observation period or at band removal. Results: The LAGB was performed in 167 patients between 2004 and 2009. The mean follow-up time was 90 ±24 months. Five (3%) patients were lost to follow-up; 37 (22.2%) had their band removed. The remaining 125 (74.8%) patients retained their bands and were included in the analysis. The mean %EWL was 33.0 ±26.6%. Thirty-one (18.6%) patients achieved %EWL > 50%. Conclusions: This study found that LAGB was not an effective bariatric procedure in long-term observation. Only 25% of 125 patients who maintained a functioning band achieved %EWL > 50%. Compliance was the only independent prognostic factor for weight loss. Other factors had no influence on outcome.

Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up

“…Similar results were obtained by other authors, who showed that the 5-year mean percentage of excess weight loss during the observation period was 34% [24]. However, a recent analysis showed that this effect was not permanent with long-term observation over 7.5 years [25].…”

“…Recent meta-analyses showed that short-and mediumterm weight loss outcomes after LAGB were poor compared with other bariatric procedures, but the number of RCT studies for the comparison in these analyses was low: only 2 RCT studies compared RYGB vs LAGB, and 1 RCT compared LAGB vs SG [18,26]. The mean 1-year %EWL for RYGB, SG, and LAGB was 67.3%, 71.2%, and 40.6%, respectively [25]. Other authors presented a case series analysis of long-term outcomes among 208 patients with LAGB [27].…”

It is really time to retire laparoscopic gastric banding? Positive outcomes after long-term follow-up: the management is the key

“…Several authors identified as positive prognostic factors for postoperative weight loss, the attendance of a high number of outpatients visits and the patients’ compliance [ 47 , 48 ]. Orlowski et al, investigated this issue in a recent review, concluding that compliance was an independent prognostic factor for weight loss after LAGB in long-term observation and older age was the only factor associated with better compliance [ 49 ]. Conversely, opposite results were reached by Leca et al on 99 LAGBs.…”

The Safety of Abdominal Contouring in the Presence of a Gastric Band

“…The device has experienced a decline in popularity as a primary bariatric surgical option due to high rates of late complications and device failure, as documented in several studies. [1][2][3][4] Understanding these potential complications is crucial when evaluating the safety of abdominal contouring procedures in Lap-Band patients, as the presence of the device can potentially impact surgical outcomes.…”