Laparoscopic Adjustable Gastric Banding Feasible in Obese Patients

October 22, 2007 — Laparoscopic adjustable gastric banding (LAGB) was a safe and feasible technique with specific indications in moderately obese patients and, secondarily, in highly obese patients who are unfit for more invasive techniques, according to the results of a prospective, randomized study reported in the October issue of the Archives of Surgery. No differences were found among the devices evaluated (the Swedish adjustable gastric band [SAGB; Obtech, Ethicon Endo-Surgery, Cincinnati, Ohio] and the Lap-Band; Inamed Health, Santa Barbara, California).
"Gastric restrictive procedures have been valid treatment options for many decades," write Gianpiero Gravante, MD, from the University of Tor Vergata and University "La Sapienza" in Rome, Italy, and colleagues. "The least invasive operation — laparoscopic adjustable gastric banding (LAGB) — has been used since 1993 as a minimally invasive alternative to various procedures. Laparoscopic adjustable gastric banding proved safe, did not require interruption of bowel continuity, and provided satisfactory long term results in terms of weight loss and correction of associated comorbidities."
Inclusion criteria for this study were body mass index (BMI) of greater than 40 kg/m2; BMI 35 to 40 kg/m2, with associated comorbidities; or BMI greater than 60 kg/m2 in patients who could not undergo derivative procedures.
Among 400 patients recruited, mean BMI decreased to 40.6 ± 3.0 kg/m2 after the first year and to 35.2 ± 7.0 kg/m2 after 2 years, with average excess weight loss reduction of 48.2% after 1 year and 56.0% after 2 years. Excess weight loss reduction was inversely related to initial weight. In 108 patients (27.0%) with an estimated weight excess of 50 kg or less, excess weight loss reduction was 55% after 2 years. In 292 patients (73.0%) with a weight excess of greater than 50 kg, excess weight loss reduction was 44% after 2 years (P = .004).
One patient (0.2%) died. The most common complications were transient gastric occlusions in 24 patients (6.0%) and slippages in 12 patients (3.0%). Correction of obesity and morbidity were similar with the SAGB and the Lap-Band.
"Laparoscopic adjustable gastric banding is a safe and feasible technique with specific indications in moderately obese patients and, secondarily, in highly obese patients who are unfit for more invasive techniques," the authors write. "Transient gastric occlusions and slippages were the most common postoperative complications. The devices used (SAGB and Lap-Band) were similar in terms of correction of obesity and morbidity."
The authors have disclosed no financial relationships.
Arch Surg. 2007;142:958-961.