Lap-Band Outcomes Called Poor Over Time

[Guest guest]

Nearly half of patients undergoing laparoscopic gastric banding for obesity

eventually needed to have the devices removed because of erosion or some

other malfunction, researchers said.

Among 82 patients followed for at least 12 years after lap-band surgery at a

single institution, 49 had at least one reoperation for complications or

device failure, according to Jacques Himpens, MD, of Saint Pierre University

Hospital in Brussels, and colleagues.

They also reported online in *Archives of Surgery* that 41 had the bands

removed during follow-up, with 14 then undergoing Roux-en-Y gastric bypass

surgery. In all but a few cases, inadequate weight loss or device breakdown

was the reason for band removal.

" The high failure rate of laparoscopic adjustable gastric banding, at least

in our hands, could be detrimental to its future continued widespread use as

a restrictive weight-loss operation, " Himpens and colleagues wrote.

But the researchers also found that, of 78 patients indicating their level

of satisfaction with the original lap-band procedure, 60% said they were

pleased or very pleased.

Moreover, on an intent-to-treat basis, patients in the study had lost 42.8%

of their original excess weight at follow-up, and the mean reduction in body

mass index was 7.8 points.

The study involved 151 consecutive patients receiving lap-band surgery

(using a device made by Bio-Enterics) from 1994 to 1997. Himpens and

colleagues tried to contact them by telephone and mail, succeeding with 82.

They suggested that the patients lost to follow-up probably had lost little

weight, insofar as regular postoperative evaluations and treatment are " a

critical factor for success in bariatric procedures. "

Among the 82 with follow-up data, 32 indicated they had suffered major

complications. These included nine cases of pouch dilation (requiring band

removal in six) and 23 instances of band erosion.

The latter was discovered after a mean of four years (SD 2.9) and led to

band removal or gastric bypass surgery in 19 cases.

As one might expect, weight loss during follow-up was greatest in patients

whose bands remained in place. From a baseline mean BMI of 42, the mean at

follow-up was about 33 in patients retaining the bands, versus 37.5 in those

whose bands were removed.

Himpens and colleagues also found that the prevalence of obesity-related

illnesses remained the same or increased over time in the cohort:

- Arterial hypertension: 25.6% at baseline, 29.5% at follow-up

- Type 2 diabetes: 6.4% at baseline, 14.1% at follow-up

- Treatment for obstructive sleep apnea: 2.6% at baseline, 7.7% at

follow-up

Himpens and colleagues acknowledged several limitations of the analysis,

notably its restriction to a single institution and the fact that

laparoscopic banding was a brand-new technology in the mid-1990s.

" There is some evidence to suggest that the more recent 'pars flaccida'

technique and the use of wider, softer bands provide better overall results

than the 'perigastric' technique that we used at the time, " the authors

observed.

But, they argued, the results still shed light on the long-term outcomes of

lap-banding. Himpens and colleagues pointed to several shorter-term studies

that showed similar results in some measures, including the degree of excess

weight loss and the incidence of pouch dilation.

The current study, though, indicated a far higher rate of band erosion than

the previous analyses (30% versus 10% or less).

In an invited critique published with the study, Clifford W. Deveney, MD, of

Oregon Health and Science University in Portland, agreed that " these data do

not shed a favorable light " on lap-band surgery.

In some ways, he noted, the procedure looks better than in earlier studies,

some of which found even higher rates of complications and inadequate weight

loss. He also noted " that a meta-analysis of studies comparing LAGB with

LRYGB demonstrated that LAGB is an easier operation that is associated with

a shorter length of hospital stay and a lower operative morbidity. "

Deveney indicated that these data, as well as institutions' own experiences,

" should influence our choice of procedure ... and the manner in which we

inform our patients " about the choice.

*Primary source: *Archives of Surgery

Source reference:

Himpens J, et al " Long-term outcomes of laparoscopic adjustable gastric

banding " *Arch Surg* 2011;

DOI:10.1001/archsurg.2011.45.<http://archsurg.ama-assn.org/cgi/content/abstract/\

archsurg.2011.45v1>

*Additional source:* Archives of Surgery

Source reference:

Deveney C " To band or to bypass, that is the question " *Arch Surg* 2011;

DOI:10.1001/archsurg.2011.45.<http://archsurg.ama-assn.org/cgi/content/extract/a\

rchsurg.2011.36v1>

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