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Band outcomes

Patient selection improves complications, weight loss

Professor Jean Marc Chevallier used predictive factors he had identified in a previous study to select patients.
Body of gastric band patients selected for age, weight, and adherence to diet and exercise lost more weight than unselected group
Results of study validate previously-identified predictive factors

Selecting patients according to predictive factors including their initial weight and their willingness to stick to diet and exercise regimes can result in greater weight loss and fewer reoperations following gastric band surgery, according to a study presented at the ASMBS’ 29th annual meeting in San Diego, California.

The study, ‘Better weight loss and less reoperation rate following laparoscopic banding in selected obese patients’, validated five factors that the authors had identified in a 2007 study as positively affecting the outcomes of surgery.

The patients had a significantly decreased rate of reoperation and reduction in morbidity compared to the historical series identified in their previous study.

The study’s lead author was Professor Jean-Marc Chevallier, of Hopital Européen Georges Pompidou, Paris.

Results

9% of patients (35) in the study suffered from complications, including 12 slippages, three food intolerances, and 14 port problems. This compares with a complication rate of 19.2% in their historical series, and rates between 33.1% and 50.4% in historical studies published by Mittermair et al, Suter et al and Van Nieuwenhove et al.

Chevallier noted, however, that these studies were based on long-term historical series involving unselected patients who were not followed up, and who received older gastric bands which are no longer used.

5.1% of patients required abdominal reoperations, compared to 17.2% in the historical series, and 3% had their bands removed, compared to 10.7% in the historical data.

Methodology

429 patients were recruited for the study between 2005 and 2011, and were followed for an average of 29.24 months.

Selection was based on five predictive factors:

  • BMI under 50 at time of surgery (mean BMI was 41.60).
  • Advanced laparoscopic team.
  • Likely to change eating behaviours.
  • Likely to practice physical activity.
  • Age under 40 (average age was 39.7 years).

40 patients dropped out during the study, and the results were based on the remaining cohort of 389 selected patients. Safety and efficacy was based on a historical series of 1227 LAGB patients identified in their 2007 study.

Chevallier also found in his 2007 study that a surgical team performing two operations per week or more is likely to have successful outcomes, with higher excess weight loss and fewer complications.

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