Gastric Band Removal Procedures Exceed Placements

Since 2013, explantation of laparoscopic adjustable gastric banding (LAGB) has exceeded that of implantation procedures at academic centers, according to a new study.

Researchers at the University of California Irvine (UCI, USA) queried the Vizient database from 2007 through 2015 to identify patients with a primary diagnosis of obesity who had undergone LAGB implantation, revision, or explantation at academic medical centers in the United States. The data were than analyzed to determine prevalence and outcomes of primary LAGB implantation, compared to revision or explantation, with outcomes measures including length of stay (LOS), intensive care unit (ICU) admission, morbidity, mortality, and cost.

The results revealed that 28,202 patients in the United States underwent LAGB implantation procedures between 2007 and 2015. During the same period, 12,157 people had their gastric bands removed. Trend analysis revealed that as of 2013, surgeons did more explantation procedures to take the gastric bands out than to put them in. LAGB revision or explantation was associated with longer LOS, higher rate of postoperative ICU admissions, and higher overall morbidity compared than implantation. There were no differences in death rates or costs, with both types of surgery averaging at USD 12,000. The study was published on July 25, 2017, in Journal of the American College of Surgeons.

“A newer alternative in weight–loss surgery, laparoscopic sleeve gastrectomy, appears to be safer and more effective [than LAGB], and may be driving this trend,” said senior author Ninh Nguyen, MD, chief of bariatric surgery at UCI. “Compared to the adjustable gastric banding, the laparoscopic sleeve gastrectomy is associated with improved weight loss and lower incidence of late complications. The late complication rate requiring revision after sleeve gastrectomy is one–fourth that of gastric banding.”

LAGB is designed to reduce the size of the stomach by placing a silicone band around the upper portion of the stomach, creating a small pouch that restricts the amount of food that can be consumed at one time, and increases the time taken for the stomach to empty. Better options for bariatric surgery include sleeve gastrectomy, biliopancreatic diversion with duodenal switch, and gastric bypass via Roux-en-Y gastric bypass (RYGBP). In the United States there has been a greater use of LAGB than other surgical procedures, probably due to the preconception that LAGB is a "simple and safer" option.

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