15 year study of banding

Ann Surg. 2013 Jan;257(1):87-94. 

Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature.
Oʼbrien PE, Macdonald L, Anderson M, Brennan L, Brown WA.
SourceFrom the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia.

Abstract
OBJECTIVE: : To describe the long-term outcomes after laparoscopic adjustable gastric banding (LAGB) and compare these with the published literature on bariatric surgery.

BACKGROUND: : Because obesity is a chronic disease, any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective. 

Yet for bariatric surgery, few long-term weight loss data are available. We report our 15-year follow-up data after LAGB and provide a systematic review of the peer-reviewed literature for weight loss at 10 years or more after bariatric surgical procedures.

METHODS: : We performed a prospective longitudinal cohort study of LAGB patients using an electronic database system (LapBase) to track progress, measure weight changes, and document revisional procedures. The evolution of the LAGB procedure was recognized, and revisional rates for 3 separate periods between September 1994 and December 2011 were described. In addition, we performed a systematic review of the peer-reviewed published literature collecting all reports that included weight loss data at or beyond 10 years.

RESULTS: : A total of 3227 patients, with a mean age of 47 years and a mean body mass index of 43.8 kg/m, were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. Follow-up was intact in 81% of patients overall and 78% of those beyond 10 years. There was no perioperative mortality for the primary placement or for any revisional procedures. 

There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. 

Revisional procedures were performed for proximal enlargement (pouch dilation) (26%), erosion (3.4%), and port and tubing problems (21%). 

The band was explanted (removed) in 5.6%. The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years. 

The revision group showed a similar weight loss to the overall group beyond 10 years. The systematic review of all bariatric procedures with 10 or more years of follow-up showed greater than 50% EWL for all current procedures. The weighted mean at maximum follow-up for LAGB was 54.2% EWL and for Roux-en-Y gastric bypass was 54.0% EWL.

CONCLUSIONS: : The LAGB study from 1 center demonstrates a durable weight loss with 47% EWL maintained to 15 years. This weight loss occurred regardless of whether any revisional procedures were needed. A systematic review shows substantial and similar long-term weight losses for LAGB and other bariatric procedures.

Very informative, Kate.  Thanks for posting.

Thanks, Kate. That is a good study. Including long term results makes it a better study than ones of a shorter term.

Thanks for posting Kate

Very interesting....1 in 4 patients had revision for pouch dilation and 1 in 5 patients for port or tubing problems.....that's eye-opening.

Gorditabonota, I agree. Very interesting. But also interesting is the point that these averages are skewed by implantation method.

"The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years." Revision does not, of course, mean to a different surgery! It means a re-op was necessary but not a band removal as the band removal rate was 6.4%. 

And a very low removal rate (6.4%) compared to the US one. I have never understood why the Australian and British figures are so very different from the US ones.

 

 

 

   

Gord...

You mentioned 1 in 4 patients had revision for pouch dilation and 1 in 5 for port or tubing issues.

These are very MINOR issues. This article indicate that the lap band is a VERY SAFE surgery long term, regardless of the lap band having annoying complications. My pouch dilation did not require hospitalization, nor was it debilitating, so most lap band complications are harmless.

The lap band CAN get dangerous if someone keeps a band too tight for long periods and vomits often and never follow up with their surgeon until the band has slipped too badly and require emergency removal, these types of complications are the patients fault and preventable..

I had a concentric pouch dilation in 2006, and it was caused by filling by Band too tight AND an undiagnosed hiatal hernia contributed to the pouch dilation and my new surgeon says that Dr. Moazzez did not calibrate my pouch correctly during installation. But my pouch dilation was manageable because I got to Dr Moazzez in time and he was able to unfill the band to remove pressure before it slipped, and over the years, I never kept the band too tight and I was careful.

Dr Moazzez was pretty NEW to banding when he installed mine and looking back and comparing it to my new band. He DID NOT INSTALL IT CORRECTLY, my new surgeon said that my OLD BAND NEVER WORKED RIGHT.  But, my pouch dilation did not require hospitalization or BAND REMOVAL,  I lived with it for nearly 7 years. I still lost weight over the years and I had a good life with my pouch being dilated.

Also my new surgeon said that my hiatal hernia was pushing up against my esophagus and that contributed to all the issues that I was having even the pouch dilation.

Comparing my first band to my new band is like day and night, I had VERY BAD heartburn and burning FROM DAY ONE with my old band. I thought  IT WAS NORMAL. Dr Moazzez put me on PPi's (Prevacid) and I felt REALLY BAD with my first lap band the first year. I suffered from burning off and on for 7 years, but I could control it with taking PPi's, but something was wrong, that something turned out to be a large hiatal hernia that Dr Moazzez never repaired and it got worse and worse and inflamed over the years and got larger.

When my new surgeon Dr Ku, removed my old band I had tons of scar tissues and he had to remove all the adhesions and repair my hernia. Scar tissue IS NORMAL with ANY SURGERY regardless if it is the lap band or not. Some people have very hard thick scar tissue and are not candidates for rebanding. Dr Ku mentioned that my scar tissue was not hard and was doable to reband me.

Since I had my revision in November, I had NO BURNING, NO PAIN, or nausea never vomiting or sliming, not even the normal post op pain, I have not required ANY PPI' s (acid reducers) since my revision surgery. Sometimes I wonder if I even have a new band inside me because I don't even feel my port. I had port pain with my old band off and on for years.  I honestly feel like Dr Ku just removed my old band and did not put a new one back in. 

I guess I got my new band replacement at a good time. I got the safer band and I had it installed properly this time and surgeons in general are MUCH more experienced with banding now than when I got my placed almost 8 years ago. Also I made SURE that my new surgeon was 'band friendly' and had installed over 500 bands. I traveled out of state to PA to get my new band installed and it was worth it.

The lap band tend to have many small annoying complications such as  reflux, burning, vomiting, port issues, they are all easily fixed, with either medication/rebanding or removal. I've experienced most of them and NONE required hospitalization . The band is the only risk that I am willing to take since all surgeries can cause complications and have risk.

 

 

These are very MINOR issues.

This is where I stopped reading......let me be very clear - any time a patient has to undergo another surgery it is MAJOR!

That's YOUR opinion...I consider a port replacement very minor and they can be done under local anesthesia, I've had minor surgery before that did not require putting me to sleep and I drove myself home about 1 hour later. If my hiatal hernia would have been repaired the first time I would have not had to get my band replaced.

Oh..yea, my band replacement was major, but my surgeon was so skilled it did not feel like it was major surgery 

Also reflux is considered a MAJOR complication with banding but it is VERY COMMON with Sleevers which requires additonal surgery if it gets unbearable, hopefully you've researched the Sleeve with your EYES wide open. Don't try to passively bash the band when you have no clue of what living with the Sleeve is like.

You are getting the Sleeve soon, something that I would not risk for nothing, but again that's MY opinion.

This is the Monash study, it's a joke. I have the full study broken down if you want to see it. Even Dr. Simpson, owner of a band mill agreed it is questionable.

What they did was to essentially remove anyone from the study that wasn't doing well and wahhh lahhhh, it makes bands look much better than they are.