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Lap-banding outcomes

Belgian study questions long-term LAGB outcomes

one in three patients experiencing band erosion

According to a study conducted at the Department of Gastrointestinal Surgery, Saint Pierre University Hospital, Brussels, Belgium, laparoscopic adjustable gastric (LAGB) banding appears to result in relatively poor long-term outcomes, with approximately one in three patients experiencing band erosion, and nearly half the patients requiring removal of their bands.

This is despite the study reporting that the majority of the patients were satisfied with the surgery and that many of them lost a significant amount of weight and kept if off after 12 years of longer.


Study outline


The study was undertaken to determine the long-term efficacy (>12 years) and safety of LAGB for morbid obesity. A total of 151 consecutive patients who had benefited from LAGB between January 1994 and December 1997 were contacted for evaluation.

The investigators evaluated mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction and quality of life.


Results


The median age of patients was 50 years (range, 28-73 years) and the operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients) with a long-term mortality rate from unrelated causes of 3.7%. A total of 22% of patients experienced minor complications and 39% experienced major complications (28% experienced band erosion).

Seventeen per cent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass and the overall (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%, range, 24%-143%). Thirty-six patients (51.4%) still had their band and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral.


Conclusion


In conclusion, the researchers said that LAGB appears to result in relatively poor long-term outcomes as one in three patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%). 


Limitations


One of the major limitations of the study is that the patients were some of the first LAGB patients to be treated, as a result the surgeons were not experienced and the technique had not evolved. In addition, the study sample was small and the study conclusions did not include the outcomes of all the patients contacted, only the outcomes of the patients who responded.

Nevertheless, LAGB did result in a mean excess weight loss of 42.8% after 12 years or longer and 60.3% of patients were satisfied, despite some undergoing a second proceed.

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