Laparoscopic Gastric Banding: A Minimally Invasive Surgical Treatment for Morbid Obesity

Franck Zinzindohoue, MD, Jean-Marc Chevallier, MD, PhD, Richard Douard, MD, Nejib Elian, MD, PhD, Jean-Marc Ferraz, MD, Jean-Philippe Blanche, MD, Jean-Louis Berta, MD, Jean-Jacques Altman, MD, Denis Safran, MD, Paul-Henri Cugnenc, MD

Disclosures

Annals of Surgery. 2003;237(1) 

In This Article

Abstract and Introduction

Objective: To evaluate early and late morbidity of laparoscopic adjustable gastric banding for morbid obesity and to assess the efficacy of this procedure by analyzing its results.
Summary Background Data: Laparoscopic adjustable gastric banding is considered the least invasive surgical option for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. It is potentially reversible and safe; major morbidity is low and there is no mortality.
Methods: Between April 1997 and June 2001, 500 patients underwent laparoscopic surgery for morbid obesity with application of an adjustable gastric band. There were 438 women and 62 men (sex ratio = 0.14) with a mean age of 40.4 years. Preoperative mean body weight was 120.7 kg and mean body mass index (BMI) was 44.3 kg. m-2.
Results: Mean operative time was 105 minutes, 84 minutes during the last 300 operations. Mean hospital stay was 4.5 days. There were no deaths. There were 12 conversions (2.4%), 2 during the last 300 operations. Fifty-two patients (10.4%) had complications requiring an abdominal reoperation. Forty-nine underwent a reoperation for minor complications: slippage (n = 43, incisional hernias (n = 3), and reconnection of the catheter (n = 3). Three patients underwent a reoperation for major complications: gastroesophageal perforation (n = 2) and gastric necrosis (n = 1). Seven patients had pulmonary complications and 36 patients experienced minor problems related to the access port. At 1-, 2-, and 3-year follow-up, mean BMI decreased from 44.3 kg. m-2 to 34.2, 32.8, and 31.9, respectively, and mean excess weight loss reached 42.8%, 52%, and 54.8%.
Conclusions: Laparoscopic adjustable gastric banding is a beneficial operation in terms of excessive weight loss, with an acceptably low complication rate. It can noticeably improve the quality of life in obese patients. Half of the excess body weight can be effortlessly lost within 2 years.

Morbid obesity carries major health hazards and reduces the quality of life. It is also life-threatening, since pulmonary, vascular, endocrine, and skeletal complications reduce life expectancy.[1] Demographic studies show a recent increase in the prevalence of morbid obesity, especially among youth, essentially related to changes in nutritional behavior. It will be a major public health challenge during the coming years.[2]

Dietary methods for weight control have inconsistent success and a high rate of weight regain.[3] Therefore, surgical options are increasingly considered in the treatment of morbid obesity. Two major categories of surgical procedures haven been considered: the first was based on generating malabsorption (e.g., an intestinal bypass) and the second on stomach volume restriction, by constructing a small proximal pouch that prevents massive food intake and limits the perception of hunger. The latter category was more frequently used in morbid obesity. The calibrated vertical banded gastroplasty, first described by Mason et al.,[4] represented an acceptable compromise between long-lasting efficacy and low morbidity.[5] On the same basis, the adjustable gastric band[6] produced similar results in terms of weight loss, with a lower risk of life-threatening complications because there was no opening or suturing of the digestive tract. The laparoscopic approach brought major advantages in terms of safety and comfort.

Success criteria are mainly health improvement and disappearance of cofactors of morbidity, during at least a 5-year follow-up. Excess weight loss is a reliable monitoring tool. In no circumstances were cosmetic concerns taken into account when operative indications were considered.

The aim of this study was to evaluate early and late morbidity and to assess the efficacy of this procedure by analyzing its results.

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