Wish people would stop hating on the band
Now I do understand how some feel about the band. In October 2006 I came to OH researching the band. I was spared being a "possible" bandster but people who are VOCAL about the POSSIBLE complications that CAN happen with the band.
I know some of you don't like them but others like myself love them.
Side comment: I know you are not talking about me but I personally have a wealth of friends just so happens my 9 to 5 is sitting in front of a computer and I have an all access pass to OH.
Ms Shell
I know some of you don't like them but others like myself love them.
Side comment: I know you are not talking about me but I personally have a wealth of friends just so happens my 9 to 5 is sitting in front of a computer and I have an all access pass to OH.
Ms Shell
"WLS is only for people who are ready to move past the "diet" mentality" ~Alison Brown
"WLS is not a Do-Over (repeat same mistakes = get a similar outcome.) It is a Do-BETTER (make lifestyle changes you can continue forever.)" ~ Michele Vicara aka Eggface
Wow, which country does your doctor practice in because that is an unheard of statistic (that for some odd reason doesn't seem to appear in any medical studies or journels)
Here are some real stats for you with sources cited:
Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).
Using 40% excess weight loss as the standard resulted in a five-year success rate of about 50%, which declined to 20% at 10 years, Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting.
Control of obesity-related comorbid conditions deteriorated similarly over time.
"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.
Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.
The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.
Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.
Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.
The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m2, and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.
Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.
When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.
A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.
Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.
On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts. Obes Surg. 2006 Jul;16(7):829-35.
A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Suter M, Calmes JM, Paroz A, Giusti V. Department of Surgery, Hôpital du Chablais, Aigle-Monthey, Switzerland.
METHODS: Prospective data of patients who had LGB have been collected since 1995, with exclusion of the first 30 patients (learning curve). Major late complications are defined as those requiring band removal (major reoperation), with or without conversion to another procedure. Failure is defined as an excess weight loss (EWL) of <25%, or major reoperation.
RESULTS: Between June 1997 and June 2003, LGB was performed in 317 patients, 43 men and 274 women. Mean age was 38 years (19-69), mean weight was 119 kg (79-179), and mean BMI was 43.5 kg/m(2) (34-78). 97.8% of the patients were available for follow-up after 3 years, 88.2% after 5 years, and 81.5% after 7 years. Overall, 105 (33.1%) of the patients developed late complications, including band erosion in 9.5%, pouch dilatation/slippage in 6.3%, and catheter- or port-related problems in 7.6%. Major reoperation was required in 21.7% of the patients. The mean EWL at 5 years was 58.5% in patients with the band still in place. The failure rate increased from 13.2% after 18 months to 23.8% at 3, 31.5% at 5, and 36.9% at 7 years.
CONCLUSIONS: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.
PMID: 16839478 [PubMed - indexed for MEDLINE]Free Article
Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation
AACE/TOS/ASMBS Guidelines
Study of Gastric Bypass vs. Banding Has Mixed Results
Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results
Weight loss (kg, BMI, %EWL) for the entire series is shown in Table 3 and in Figures 2, 3 and 4.
At 10 years, the average weight was 101.4 ± 27.1 kg (loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5
points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ≤49) and superobese (BMI ≥50) were separated into two groups for evaluation/comparison and weight loss in terms of kg and BMI is reported in Table 4 and shown in Figures 5 and 6. At 10 years the weight of the morbidly obese group was 94.6 ± 18.0 kg of the superobese group and was 123.2 ± 38.5 kg, indicating weight losses of 23.8 kg and 29.6 kg, respectively.
At 10 years, the BMI in the morbidly obese group was 35.2 ± 5.4 and in the super-obese group was 44.9
± 13.9, down 7.4 and 11.3 points, respectively. The %EWL in the morbidly and super-obese groups is reported in Table 5 and shown in Figure 7. At 10 years, %EWL was 40.3 ± 27.6 and 36.0 ± 30.2, respectively.
Table 3. Weight loss (kg, BMI, %EWL) of the entire series
Time Weight BMI %EWL*
0 127.7±24.3 46.2±7.7 ---
1 y 103.7±21.6 37.7±7.1 40.3±19.7
2 y 101.5±23.3 36.8±7.6 43.7±21.7
3 y 102.5±22.5 37.2±7.2 41.2±23.2
4 y 104.1±23.5 37.8±7.5 38.6±24.4
5 y 105.0±23.6 38.1±7.6 37.3±25.3
6 y 105.3±24.6 38.1±8.1 37.4±28.2
7 y 106.8±24.3 38.5±7.9 35.9±26.7
8 y 105.0±24.0 37.8±7.9 37.7±26.7
9 y 103.3±26.2 37.5±8.5 38.5±27.9
10 y 101.4±27.1 37.7±9.1 35.4±29.6
11 y 101.2±31.9 38.1±11.5 38.4±32.8
12 y 84.0±27.5 31.6±8.5 49.2±49.5
Values are mean ± SD. *Based on Metropolitan tables (to put this in perspective my BMI is 38 right now, I'm 5'4" and 220 lbs)
Lap Band Complications (this information is onAllegan's web site the people who make the band http://www.lapband.com/en/learn_about_lapband/safety_information//)
Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their gastric banding systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function****urred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing****urred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.
Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, *****ly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you don't understand
You're right, its not high school - you can't bully people out for sharing their personal stories and pure FACT. Maybe you should do some homework?
Here are some real stats for you with sources cited:
Studies
Adjustable gastric band to sleeve conversions/revisions
September 18th, 2010 Posted in Bariatric surgery, LapBand, Realize Band, Vertical gastrectomy, Weight loss surgery results, surgical weight loss, weight loss plan, weight loss surgery As the popularity of adjustable gastric banding has increased in the United States, so have the problems associated with this approach to weight loss. Issues with band slips, erosions and most commonly inadequate weight loss surgery results or weight regain have become an increasing problem which weight loss surgery physicians must now address. Long-term data on the success of the adjustable gastric band (LapBand® and Realize® Band ) has shown consistent results with regards to surgical weight loss. Published studies in bariatric laparoscopic surgery report average percentage excess weight loss (%EWL) of 30%-60%, but vary widely. The most accurate reports appear to indicate a range of 40%-55% EWL in patients who have been followed for more than 5 years. Perhaps a more important issue (and more neglected) is the long-term complication and failure rate of these devices. Some reports in the literature looking at results in patients 8-10 years after surgery report up to a 25% explantation (removal) rate, 6-10% rate of reoperation to address complications and 40% failure rate. With more than 400,000 adjustable gastric bands implanted worldwide, this stands to become a sizable problem. Because of these issues, forward-thinking bariatric surgeons have implemented strategies and algorithms to deal with failures and complications of these devices. Dr. Paul Cirangle, a pioneer of and one of the world’s experts on the Vertical Sleeve Gastrectomy (VSG), deals with conversions from the adjustable gastric band (AGB) to the Sleeve Gastrectomy on a frequent basis. He has recently reviewed his extensive bariatric surgery experience with these conversions and has found some very interesting findings. The incidence of patients complaining of “troubled eating" (pain with swallowing, regurgitation, heartburn or reflux) was extremely high (>60%), even in individuals who were successful in losing weight with the band. Among those who were not successful in losing an adequate amount of weight, many stated that dense foods were so uncomfortable to consume. This results in gravitating towards softer foods such as mashed potatoes and pasta, making it essentially impossible for them to reach their surgical weight loss goals. In the time period between July 2005 and July 2010, 69 adjustable gastric bands have been revised to a Vertical Sleeve Gastrectomy. The results in terms of %EWL, reduction of appetite and overall sense of satiety have been excellent – essentially the same as in patients undergoing a sleeve gastrectomy as a primary procedure. When asked about the subjective difference, all patients concurred that the VSG produced little or no episodes of “troubled eating" and was universally superior in regards to satiety and suppression of appetite in comparison to the AGB.27 June 2010
ASMBS: Gastric Banding Gets Low Marks
ASMBS: Gastric Banding Gets Low Marks,LAS VEGAS -- Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients, a Dutch surgeon said here.Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).
Using 40% excess weight loss as the standard resulted in a five-year success rate of about 50%, which declined to 20% at 10 years, Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting.
Control of obesity-related comorbid conditions deteriorated similarly over time.
"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.
Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.
The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.
Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.
Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.
The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m2, and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.
Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.
When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.
A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.
Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.
On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts. Obes Surg. 2006 Jul;16(7):829-35.
A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Suter M, Calmes JM, Paroz A, Giusti V. Department of Surgery, Hôpital du Chablais, Aigle-Monthey, Switzerland.
Abstract
BACKGROUND: Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of choice for morbid obesity. Few long-term studies have been published. We present our results after up to 8 years (mean 74 months) of follow-up.METHODS: Prospective data of patients who had LGB have been collected since 1995, with exclusion of the first 30 patients (learning curve). Major late complications are defined as those requiring band removal (major reoperation), with or without conversion to another procedure. Failure is defined as an excess weight loss (EWL) of <25%, or major reoperation.
RESULTS: Between June 1997 and June 2003, LGB was performed in 317 patients, 43 men and 274 women. Mean age was 38 years (19-69), mean weight was 119 kg (79-179), and mean BMI was 43.5 kg/m(2) (34-78). 97.8% of the patients were available for follow-up after 3 years, 88.2% after 5 years, and 81.5% after 7 years. Overall, 105 (33.1%) of the patients developed late complications, including band erosion in 9.5%, pouch dilatation/slippage in 6.3%, and catheter- or port-related problems in 7.6%. Major reoperation was required in 21.7% of the patients. The mean EWL at 5 years was 58.5% in patients with the band still in place. The failure rate increased from 13.2% after 18 months to 23.8% at 3, 31.5% at 5, and 36.9% at 7 years.
CONCLUSIONS: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.
PMID: 16839478 [PubMed - indexed for MEDLINE]Free Article
Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation
AACE/TOS/ASMBS Guidelines
Study of Gastric Bypass vs. Banding Has Mixed Results
Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results
Weight loss (kg, BMI, %EWL) for the entire series is shown in Table 3 and in Figures 2, 3 and 4.
At 10 years, the average weight was 101.4 ± 27.1 kg (loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5
points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ≤49) and superobese (BMI ≥50) were separated into two groups for evaluation/comparison and weight loss in terms of kg and BMI is reported in Table 4 and shown in Figures 5 and 6. At 10 years the weight of the morbidly obese group was 94.6 ± 18.0 kg of the superobese group and was 123.2 ± 38.5 kg, indicating weight losses of 23.8 kg and 29.6 kg, respectively.
At 10 years, the BMI in the morbidly obese group was 35.2 ± 5.4 and in the super-obese group was 44.9
± 13.9, down 7.4 and 11.3 points, respectively. The %EWL in the morbidly and super-obese groups is reported in Table 5 and shown in Figure 7. At 10 years, %EWL was 40.3 ± 27.6 and 36.0 ± 30.2, respectively.
Table 3. Weight loss (kg, BMI, %EWL) of the entire series
Time Weight BMI %EWL*
0 127.7±24.3 46.2±7.7 ---
1 y 103.7±21.6 37.7±7.1 40.3±19.7
2 y 101.5±23.3 36.8±7.6 43.7±21.7
3 y 102.5±22.5 37.2±7.2 41.2±23.2
4 y 104.1±23.5 37.8±7.5 38.6±24.4
5 y 105.0±23.6 38.1±7.6 37.3±25.3
6 y 105.3±24.6 38.1±8.1 37.4±28.2
7 y 106.8±24.3 38.5±7.9 35.9±26.7
8 y 105.0±24.0 37.8±7.9 37.7±26.7
9 y 103.3±26.2 37.5±8.5 38.5±27.9
10 y 101.4±27.1 37.7±9.1 35.4±29.6
11 y 101.2±31.9 38.1±11.5 38.4±32.8
12 y 84.0±27.5 31.6±8.5 49.2±49.5
Values are mean ± SD. *Based on Metropolitan tables (to put this in perspective my BMI is 38 right now, I'm 5'4" and 220 lbs)
Lap Band Complications (this information is onAllegan's web site the people who make the band http://www.lapband.com/en/learn_about_lapband/safety_information//)
Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their gastric banding systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function****urred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing****urred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.
Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, *****ly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you don't understand
You're right, its not high school - you can't bully people out for sharing their personal stories and pure FACT. Maybe you should do some homework?
Lynn C ~
Banded 9/12/2005 ~ Revision to VSG on 9/7/2010 ~ Losing again with a Keto lifestyle
On January 13, 2011 at 12:19 PM Pacific Time, Lynn B wrote:
Wow, which country does your doctor practice in because that is an unheard of statistic (that for some odd reason doesn't seem to appear in any medical studies or journels)Here are some real stats for you with sources cited:
Studies
Adjustable gastric band to sleeve conversions/revisions
September 18th, 2010 Posted in Bariatric surgery, LapBand, Realize Band, Vertical gastrectomy, Weight loss surgery results, surgical weight loss, weight loss plan, weight loss surgery As the popularity of adjustable gastric banding has increased in the United States, so have the problems associated with this approach to weight loss. Issues with band slips, erosions and most commonly inadequate weight loss surgery results or weight regain have become an increasing problem which weight loss surgery physicians must now address. Long-term data on the success of the adjustable gastric band (LapBand® and Realize® Band ) has shown consistent results with regards to surgical weight loss. Published studies in bariatric laparoscopic surgery report average percentage excess weight loss (%EWL) of 30%-60%, but vary widely. The most accurate reports appear to indicate a range of 40%-55% EWL in patients who have been followed for more than 5 years. Perhaps a more important issue (and more neglected) is the long-term complication and failure rate of these devices. Some reports in the literature looking at results in patients 8-10 years after surgery report up to a 25% explantation (removal) rate, 6-10% rate of reoperation to address complications and 40% failure rate. With more than 400,000 adjustable gastric bands implanted worldwide, this stands to become a sizable problem. Because of these issues, forward-thinking bariatric surgeons have implemented strategies and algorithms to deal with failures and complications of these devices. Dr. Paul Cirangle, a pioneer of and one of the world’s experts on the Vertical Sleeve Gastrectomy (VSG), deals with conversions from the adjustable gastric band (AGB) to the Sleeve Gastrectomy on a frequent basis. He has recently reviewed his extensive bariatric surgery experience with these conversions and has found some very interesting findings. The incidence of patients complaining of “troubled eating" (pain with swallowing, regurgitation, heartburn or reflux) was extremely high (>60%), even in individuals who were successful in losing weight with the band. Among those who were not successful in losing an adequate amount of weight, many stated that dense foods were so uncomfortable to consume. This results in gravitating towards softer foods such as mashed potatoes and pasta, making it essentially impossible for them to reach their surgical weight loss goals. In the time period between July 2005 and July 2010, 69 adjustable gastric bands have been revised to a Vertical Sleeve Gastrectomy. The results in terms of %EWL, reduction of appetite and overall sense of satiety have been excellent – essentially the same as in patients undergoing a sleeve gastrectomy as a primary procedure. When asked about the subjective difference, all patients concurred that the VSG produced little or no episodes of “troubled eating" and was universally superior in regards to satiety and suppression of appetite in comparison to the AGB.27 June 2010
ASMBS: Gastric Banding Gets Low Marks
ASMBS: Gastric Banding Gets Low Marks,LAS VEGAS -- Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients, a Dutch surgeon said here.Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).
Using 40% excess weight loss as the standard resulted in a five-year success rate of about 50%, which declined to 20% at 10 years, Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting.
Control of obesity-related comorbid conditions deteriorated similarly over time.
"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.
Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.
The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.
Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.
Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.
The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m2, and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.
Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.
When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.
A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.
Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.
On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts. Obes Surg. 2006 Jul;16(7):829-35.
A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Suter M, Calmes JM, Paroz A, Giusti V. Department of Surgery, Hôpital du Chablais, Aigle-Monthey, Switzerland.
Abstract
BACKGROUND: Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of choice for morbid obesity. Few long-term studies have been published. We present our results after up to 8 years (mean 74 months) of follow-up.METHODS: Prospective data of patients who had LGB have been collected since 1995, with exclusion of the first 30 patients (learning curve). Major late complications are defined as those requiring band removal (major reoperation), with or without conversion to another procedure. Failure is defined as an excess weight loss (EWL) of <25%, or major reoperation.
RESULTS: Between June 1997 and June 2003, LGB was performed in 317 patients, 43 men and 274 women. Mean age was 38 years (19-69), mean weight was 119 kg (79-179), and mean BMI was 43.5 kg/m(2) (34-78). 97.8% of the patients were available for follow-up after 3 years, 88.2% after 5 years, and 81.5% after 7 years. Overall, 105 (33.1%) of the patients developed late complications, including band erosion in 9.5%, pouch dilatation/slippage in 6.3%, and catheter- or port-related problems in 7.6%. Major reoperation was required in 21.7% of the patients. The mean EWL at 5 years was 58.5% in patients with the band still in place. The failure rate increased from 13.2% after 18 months to 23.8% at 3, 31.5% at 5, and 36.9% at 7 years.
CONCLUSIONS: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.
PMID: 16839478 [PubMed - indexed for MEDLINE]Free Article
Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation
AACE/TOS/ASMBS Guidelines
Study of Gastric Bypass vs. Banding Has Mixed Results
Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results
Weight loss (kg, BMI, %EWL) for the entire series is shown in Table 3 and in Figures 2, 3 and 4.
At 10 years, the average weight was 101.4 ± 27.1 kg (loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5
points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ≤49) and superobese (BMI ≥50) were separated into two groups for evaluation/comparison and weight loss in terms of kg and BMI is reported in Table 4 and shown in Figures 5 and 6. At 10 years the weight of the morbidly obese group was 94.6 ± 18.0 kg of the superobese group and was 123.2 ± 38.5 kg, indicating weight losses of 23.8 kg and 29.6 kg, respectively.
At 10 years, the BMI in the morbidly obese group was 35.2 ± 5.4 and in the super-obese group was 44.9
± 13.9, down 7.4 and 11.3 points, respectively. The %EWL in the morbidly and super-obese groups is reported in Table 5 and shown in Figure 7. At 10 years, %EWL was 40.3 ± 27.6 and 36.0 ± 30.2, respectively.
Table 3. Weight loss (kg, BMI, %EWL) of the entire series
Time Weight BMI %EWL*
0 127.7±24.3 46.2±7.7 ---
1 y 103.7±21.6 37.7±7.1 40.3±19.7
2 y 101.5±23.3 36.8±7.6 43.7±21.7
3 y 102.5±22.5 37.2±7.2 41.2±23.2
4 y 104.1±23.5 37.8±7.5 38.6±24.4
5 y 105.0±23.6 38.1±7.6 37.3±25.3
6 y 105.3±24.6 38.1±8.1 37.4±28.2
7 y 106.8±24.3 38.5±7.9 35.9±26.7
8 y 105.0±24.0 37.8±7.9 37.7±26.7
9 y 103.3±26.2 37.5±8.5 38.5±27.9
10 y 101.4±27.1 37.7±9.1 35.4±29.6
11 y 101.2±31.9 38.1±11.5 38.4±32.8
12 y 84.0±27.5 31.6±8.5 49.2±49.5
Values are mean ± SD. *Based on Metropolitan tables (to put this in perspective my BMI is 38 right now, I'm 5'4" and 220 lbs)
Lap Band Complications (this information is onAllegan's web site the people who make the band http://www.lapband.com/en/learn_about_lapband/safety_information//)
Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their gastric banding systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function****urred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing****urred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.
Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, *****ly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you don't understand
You're right, its not high school - you can't bully people out for sharing their personal stories and pure FACT. Maybe you should do some homework?
You're right, its not high school - you can't bully people out for sharing their personal stories and pure FACT.
Ok, well, had you actually discussed and disseminated what you think about these statistics IN YOUR OWN WORDS and what is the most pertinent information here as well as why you think it is important for you and for everyone else, people would be much more apt to stop and listen and engage you in a productive conversation, rather than seeing you as a smug ass who knows how to copy and paste.
Can't make everyone happy - you post your story people whine that its your opinion, post the facts that they ask for and they whine that you didn't post your story - the link at the bottom of each and every one of my post provides both if you're so inclined.
I do have productive conversations with the people that PM me after they've read the studies. Don't sell potential bansters short, some of them are very intelligent they just need to know where to go to get the info they need. The others - the ones that whine that I post them because they are doing AWESOME with their bands, I don't really care what they think and I'm not interested in discussing the pro's and con's of the band with them.
Apparently you also know how to copy and paste - does that make you a smug ass to or were you hoping that I'd be impressed with your big words?
I do have productive conversations with the people that PM me after they've read the studies. Don't sell potential bansters short, some of them are very intelligent they just need to know where to go to get the info they need. The others - the ones that whine that I post them because they are doing AWESOME with their bands, I don't really care what they think and I'm not interested in discussing the pro's and con's of the band with them.
Apparently you also know how to copy and paste - does that make you a smug ass to or were you hoping that I'd be impressed with your big words?
Lynn C ~
Banded 9/12/2005 ~ Revision to VSG on 9/7/2010 ~ Losing again with a Keto lifestyle
I get most of my information from the band maker, Allergan and the ASMBS. I have posted the links repeatedly.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
And I wish the band would stop NOT working! But it doesn't look like I'm gonna get my wish either.
I don't know why u would just skim through just the possitive posts. I would think u would want the truth about the band. Those positive posts are just PART of the truth! U are saying the band works. Excuse me...............U HAVE HAD THE BAND 3 MOS.! The band is obviouosly working for u NOW. Does NOT mean it will continue to work!!! And for some ppl it NEVER will work! And u want to keep that info from those that are considering the band?!?!?! I think that is rather selfish of u! If someone is pre-op they have a right to come on this forum and hear the TRUTH about the band. Just as u have a right to come on here and say how much u love your band. U know the nazi's tried to censor also!
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