LAPBAND - The Real Story

There has been much discussion on our PacLap yahoo online group support about LapBands. We have done a recent review of the literature and would like to share with you some of the current information in peer-reviewed literature:

Resolution of CoMorbidities

Resolution of CoMorbidities
	RNY	DS	LapBand
Diabetes	83.7%	98.9%	47.9%
Hyperlipidemia	96.9%	99.1%	58.9%
Hypertension	67.5%	83.4%	43.2%
Sleep Apnea	80.4%	92%	95%
Operative Mortality	0.5%	1.1%	0.1%
		(PacLap <.03%)
Excess Wt. Loss	67.5%	70.1%	47.5%
		(PacLap 91% @ 2 yrs) (2)

Bariatric Surgery

1. A Systematic Review and Meta-analysis, Henry Buchwald, MD, PhD, et al, JAMA, October 13, 2004, Vol 292, No 14
The data presented here is from 1990-2003 and reviewed 22,094 patients.

2. Laparoscopic Technique for Performing Duodenal Switch with Gastric Reduction, Robert A. Rabkin, MD, FACS, et al, Obesity Surgery, 13, 2003,263-268

3 Recent peer reviewed articles are listed below:

Thirteen Years of Follow-up in Patients with Adjustable Silicone Gastric Banding for Obesity: Weight Loss and Constant Rate of Late Specific Complications, Giovanni Camerini, MD and others.

Background: Despite its simplicity, safety and good short-term results, progressive weight regain and a high incidence of complications have been reported after the adjustable silicone gastric banding (ASGB). The aim of this study is to evaluate the long-term results of this operation in our patient population.

“We encountered both early and late complications which required re-operative surgery in more than 2/3’s of the patients and device removal in more than ½.”

“Let us not forget that VBG (Vertical Banded Gastroplasty), after 20 years of clinical use, has been largely abandoned in the USA because of the disappointing 10-year results.”

“However, adjustable gastric banding is still very appealing, and reports are appearing from Europe. The aim of this paper, based on the longest existing follow-up, is to provide a warning. The surgeon who adopts the LAGB operation, encouraged by the good short-term results, can potentially carry out a great number of these operations in a short period of time. Should the long-term outcome be similar to ours, this discovery would be more costly with a larger series than with a small one.”

Conclusion: ASGB yielded good short-term results, but the progressive weight regain and constant risk of complications in the long term tend to nullify the optimism.

A 10-Year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates, M. Suter, MD,PD, FACS and others. Obesity Surgery, 16, 829-935

Background: Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of Choice for Morbid obesity. Few long-term studies have been published. We present our results after up to 8 years (means 74 months) of follow-up.

“In this paper, reporting on a small group of 45 patients, but with the longest mean follow-up ever reported (105 months), the authors found a 76% incidence of late specific complications. In this series, we found that the rate of long-term complications, and especially that of major long=term complications increases constantly over time, according to a linear pattern. Progressive food intolerance, sometimes associated with reflux and/or esophageal dilatation, is another late complication, and increases over time.”

Conclusion: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable Excess Weight Loss in the long term. Each year adds 3-4 % to the major complication rate, which contributes to the total failure rate. With a nearly 40 % 5-year failure rate, and a 43 % 7-year success rate (EWL>50%) LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.”

Laparoscopic Adjustable Gastric Banding Versus Laparoscopic Roux-en-Y Gastric Bypass: 5 Years results of a Prospective Randomized Trial. Luigi Angrisani, MD and others. SOARD 2 (2006) 286-309

Background: Prospective randomized comparison of Lap Adjustable Gastric Banding (LAGB) versus Lap Roux-en-Y Gastric Bypass is lacking.

Conclusion: Lap Roux-en Y Gastric Bypass compared to LapAdjustable Banding produces better weight loss and reduced number of failures, despite significantly longer operative time and life threatening complications. Predictive criteria of success for LapBand need to be investigated.