Long-term results of bariatric restrictive procedures

July 18, 2011

Obes Surg. 2010 Dec;20(12):1617-26.

Long-term results of bariatric restrictive procedures: a prospective study.

Schouten R, Wiryasaputra DC, van Dielen FM, van Gemert WG, Greve JW.

Source

Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.

schoutenruben@...

Abstract

Laparoscopic adjustable gastric banding (LAGB) and vertical-banded gastroplasty

(VBG) are surgical treatment modalities for morbid obesity. This prospective

study describes the long-term results of LAGB and VBG. One hundred patients were

included in the study. Fifty patients underwent LAGB and 50 patients, open VBG.

Study parameters were weight loss, changes in obesity-related comorbidities,

long-term complications, re-operations including conversions to other bariatric

procedures and laboratory parameters including vitamin status. From 91 patients

(91%), data were obtained with a mean follow-up duration of 84 months (7 years).

Weight loss [percent excess weight loss (EWL)] was significantly more after VBG

compared with LAGB, 66% versus 54%, respectively. All comorbidities

significantly decreased in both groups. Long-term complications after VBG were

mainly staple line disruption (54%) and incisional hernia (27%). After LAGB, the

most frequent complications were pouch dilatation (21%) and anterior slippage

(17%). Major re-operations after VBG were performed in 60% of patients. All

re-operations following were conversions to Roux-en-Y gastric bypass (RYGB). In

the LAGB group, 33% of patients had a refixation or replacement of the band, and

11% underwent conversion to another bariatric procedure. There were no

significant differences in weight loss between patients with or without

re-interventions. No vitamin deficiencies were present after 7 years, although

supplement usage was inconsistent. This long-term follow-up study confirms the

high occurrence of late complications after restrictive bariatric surgery. The

failure rate of 65% after VBG is too high, and this procedure is not performed

anymore in our institution. The re-operation rate after LAGB is decreasing as a

result of new techniques and materials. Results of the re-operations are good

with sustained weight loss and reduction in comorbidities. However, in order to

achieve these results, a durable and complete follow-up after restrictive

procedures is imperative.

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