Gastric Banding Has Poor Long-Term Outcomes

Laparoscopic adjustable gastric banding (LAGB), an obesity treatment gaining wider acceptance, appears to produce relatively poor long-term outcomes, according to a new study.

Researchers at Saint Pierre University Hospital (Brussels, Belgium) conducted a clinical assessment of 151 consecutive patients (median age 50 years) who had benefited from LAGB between January 1, 1994, and December 31, 1997, to determine the long-term efficacy and safety of LAGB for morbid obesity 12 years after the procedure. The main outcome measures were mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of co-morbidities, patient satisfaction, and quality of life.

The results showed that the overall rate of follow-up was 54.3%. The long-term mortality rate from unrelated causes was 3.7%, but operative mortality rate was zero. In all, 22% of the patients experienced minor complications, and 39% experienced major complications, including 28% who experienced band erosion; 17% of the patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the mean excess weight loss was 42.8%; 36 patients (51.4%) still had their band, and their mean excess weight loss was 48%. The quality-of-life score was neutral, and satisfaction index was good for 60.3% of patients. The study was published in the March 21, 2011, issue of the Archives of Surgery.

"Nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands, contributing to a reoperation rate of 60%,” concluded lead author Jacque Himpens, MD, and colleagues of the department of gastrointestinal surgery. "The high failure rate of LAGB, at least in our hands, could be detrimental to its future continued widespread use as a restrictive weight loss operation.”

The researchers clarified that as the procedures were performed in the 1990s, they had used the older perigastric dissection technique. Some current evidence, however, suggests that the more recent pars flaccida technique, combined with wider, softer bands, may provide better overall results.

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