Gastric Banding Has Poor Long-Term Outcomes

March 21, 2011

March 21, 2011 — Laparoscopic adjustable gastric banding (LAGB), an obesity treatment gaining wider acceptance, appears to produce "relatively poor long-term outcomes," according to a study of 151 patients published online today in the Archives of Surgery.

Nearly 30% of patients in the study experienced band erosion, nearly half needed to have their band removed, and 60% overall required some kind of reoperation.

Adjustable gastric band

In February, the US Food and Drug Administration (FDA) lowered the body mass index (BMI) requirements for a LAGB product on the market called the Lap-Band Adjustable Gastric Banding System (Allergan). Previously, the device was indicated for adults with a BMI of 40 kg/m2 or higher and those with a BMI of 35 kg/m2 or higher who had additional risk factors. The agency extended the indication to adults with a BMI of 30 to 40 kg/m2 and 1 additional obesity-related condition — such as diabetes or hypertension — who have failed to lose weight with diet, exercise, and pharmacotherapy.

Study Involved Older Surgical Technique

The study in the Archives of Surgery looked at 151 patients who underwent LAGB in Belgium between January 1, 1994, and December 31, 1997. Eighty-two of the patients were available for a full evaluation in late 2009. Of these, 3 had died of causes unrelated to the procedure.

Of the 82 patients evaluated, 22% experienced minor complications, and 39% major ones. Forty-five percent had their bands removed, and 17% were switched to laparoscopic Roux-en Y gastric bypass.

Complete weight loss data were available for 70 patients. Thirty-six had their band in place when evaluated and had lost 48% of their excess weight compared with 64% for patients who underwent laparoscopic Roux-en Y gastric bypass. Overall, of 78 patients questioned, 60% said they were pleased or very pleased with their gastric banding surgery.

The authors, who had performed the procedures in the 1990s, note that they had used the older perigastric dissection technique. Some evidence, they write, suggests that the more recent pars flaccida technique, combined with wider, softer bands, provide better overall results.

Although the authors state that reliance on the older technique may limit their study, they add that some surgeons still continue to use the perigastric method because their research shows it to be roughly equivalent to the pars flaccida counterpart. Despite this and other "criticizable aspects" of the study, the authors still believe they have shed light on the long-term outcomes of LAGB.

"The high failure rate of LAGB, at least in our hands," they write, "could be detrimental to its future continued widespread use as a restrictive weight loss operation."

Lead study author Jacque Himpens, MD, is a consultant with Ethicon Endosurgery and Covidien. Coauthor Guy-Bernard Cadière, MD, PhD, is a consultant with Ethicon Endosurgery and Storz. Coauthor Giovanni Dapri, MD, also is a consultant with Storz.

Arch Surg. Published online March 21, 2010.

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