Surgical Treatment of Severe Obesity With a Low-Pressure Adjustable Gastric Band: Experimental Data and Clinical Results in 625 Patients

Wim Ceelen, MD, Jean Walder, MD, Anne Cardon, MD, Katrien Van Renterghem, MD, Uwe Hesse, MD, PhD, Mohamed El Malt, MD, PhD, Piet Pattyn, MD, PhD

Disclosures

Annals of Surgery. 2003;237(1) 

In This Article

Abstract and Introduction

Objective: To evaluate the use of a low-pressure gastric band in the treatment of severe obesity in a prospective study.
Summary Background Data: Gastric banding for severe obesity has been associated with erosion and perforation of the stomach. The Swedish adjustable gastric band (SAGB) has been proposed as a low-pressure device.
Methods: From January 1998 to October 2001, 625 patients underwent laparoscopic SAGB. Median age was 36 years, and 80.4% of patients were female. Median preoperative body mass index (BMI) was 40. Previous upper abdominal surgery was reported in 36 (6%) patients. A five-trocar technique was used without a calibration balloon.
Results: Median follow-up was 19.5 months. All patients were treated laparoscopically with a median operating time of 80 minutes. Conversion was necessary in two patients (0.3%): one trocar injury of the mesentery and one esophageal perforation. Median hospital stay was 3 days; there were no 30-day deaths. Early morbidity was present in 27 patients (4.3%). Late band reoperation was necessary in 49 patients (7.8%). Indications for reoperation were band slippage or pouch dilation, acute total dysphagia, and band leakage or malfunction. Median excess weight loss was 45.8%, 49.9%, and 47.4% after 1, 2, and 3 years, respectively, with a measurable beneficial effect on arterial hypertension, sleep apnea syndrome, and diabetes control.
Conclusions: SAGB is a safe and effective new method in the management of severe obesity. Long-term follow-up (>3 years) is necessary to confirm its effectiveness and safety.

Obesity is a major healthcare issue in both industrialized and industrializing nations.[1] The prevalence of obesity (body mass index [BMI] 30 or more) in the United States was 19.8% in 2000.[2] Well-known adverse effects of obesity include cardiovascular disease, diabetes mellitus, and various types of cancer.

Surgical treatment can be offered to patients with clinically severe (morbid) obesity (BMI > 40 or > 35 with associated morbidities) in whom dietary and medical therapies have failed. A variety of restrictive and malabsorption-inducing procedures have been proposed to treat clinically severe obesity. Laparoscopic gastric banding offers the advantages of minimally invasive surgery, adjustability, and reversibility. Mainly in Europe and Australia, a large experience exists with the original Lap-Band device (BioEnterics, Carpinteria, CA).[3,4] Concern exists, however, regarding band erosion, slippage, and pouch or esophageal dilatation, leading to reoperation in up to 50% of patients.[5,6] Some of these adverse effects could be related to the relatively high pressure exerted by the band on the esophageal and gastric wall. The Swedish adjustable gastric band (SAGB) (Obtech Medical, Baar, Switzerland) was engineered as a low-pressure device and has been introduced into clinical practice.[7,8,9] We previously reported superior results with this new band and have not used the Lap-Band since 1998.[10] This article reports the first large consecutive series of prospectively followed severely obese patients treated with the SAGB.

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