Laparoscopic adjustable gastric banding for massive superobesity ( > 60 body mass index kg/m 2 )

Abstract

Surgery for massive super obesity is a formidable challenge. No existing open or laparoscopic procedure reduces BMI below 30 from a starting point above 55. Laparoscopic adjustable gastric banding has been used to treat 76 massive super obese patients with a BMI > 60 kgs/m2. Median weight was 193 kgs +/-34.7 kgs (154-335 kgs). Five patients had a BMI > 100 kgs/m2. There was neither mortality nor pulmonary emboli. hospital stay was 3 days (1-6 days). Excess weight loss was 46.69 +/-10.5 at 1 year; 59.14 +/- 11.7% at 3 years and 61 +/- 15.1% at 5 years. At 2 years, 84% of the patients had greater than 50% excess weight loss and this was maintained at 3, 4, and 5 years. BMI fell from 69 +/- 6.2 to 49 +/- 7.73 at 1 year to 37 +/- 4.45 at 3 years and this was maintained at 4 and 5 years. BMI in 13 patients with > 5 year follow up was 35.09 +/- 53 kgs/m2 (27-44). Weight loss with laparoscopic adjustable gastric banding in this group of massive super obese patients has been similar to all other surgical techniques with reduction of BMI from 69 to 33 kgs/m2 at 3 years. The relative safety of the Lapband avoids bowel surgery in these very big patients, suggesting that laparoscopic adjustable gastric banding is a valid surgical approach to these difficult patients.

Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis

“…As proven by recent studies [8,15], other factors, such as BMI and age, influence the final outcome in gastric bypass. For this reason, Fielding [9] advocates performing laparoscopic adjustable gastric banding as a standard technique because it is the simplest technique with the lowest risk, with a mortality rate of 0% in SO patients; however, his oldest patient was only 51 years old.…”

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

“…There was 59% of effective weight loss for laparoscopic adjustable gastric banding at 8 years, and 52% of effective weight loss for Roux-en-Y gastric bypass at 10 years. In another study (Fielding, 2003), weight evolution of obese patients was assessed at 3 and 5 years after laparoscopic adjustable gastric banding, but the weight was not evaluated at 10 years. However, these studies did not emphasize the weight loss results according to the time spent since surgery.…”

Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

“…Therefore, in patients with milder degrees of obesity, procedures that produce greater absolute weight loss may not be advantageous, although this can only regarded as a recommendation by rule of thumb. However, the reverse conclusion, that gastric banding and VBG should not be used in massive obesity, does not seem to fully apply, because recent reports showed that LAGB is associated with sufficient EWL also in patients with a BMI of 60 to 100 (EL 2b [86]; EL 4 [96]). …”