Weight Loss w/Gastric Band durable beyond 10 years study

Heartwire January 24, 2013 Posted:

MELBOURNE, Australia — Laparoscopic adjustable gastric banding results in significant weight loss that is maintained for more than a decade, research shows [1]. The procedure, which cut excess weight by nearly 50% over 10 years, was successful even in patients *****quired additional procedures, such as those *****quired follow-up surgery to adjust the gastric band, report investigators in the January 2013 issue of the Annals of Surgery.

"The study shows that you are getting a very durable effect with the procedure," lead investigator Dr Paul O'Brien (Monash University, Melbourne, Australia) told heartwire . "We have already shown that the band is effective in getting half of the excess off, and we know that it helps with health and quality of life. Now we can say that this effect lasts. Getting a short-term effect is not that helpful for a patient who is 30, 40, or 50 years old."

The investigators performed a longitudinal cohort study to track progress, measure weight changes, and document any additional procedures of 3227 patients who underwent laparoscopic adjustable gastric banding for weight loss. The mean body-mass index (BMI) of the patients was 43.8 kg/m², and the mean age was 47.0 years.

To heartwire , O'Brien said that laparoscopic gastric banding is approved for patients with a BMI of 30, but he treats very few patients in the 30- to 35-BMI range. Patients typically treated are considered severely obese, and approximately 10% have diabetes mellitus. Hypertension is more prevalent, occurring in 30% to 40% of patients, while sleep apnea, back pain, and neck pain are very common. He explained that the quality of life of the severely obese is extremely limited, with many patients isolated and embarrassed by their weight. Many are unemployed

and have a number of psychosocial problems associated with obesity.

"A lot of patients come to see us because of concerns about life expectancy," said O'Brien. "They can see that they're getting into trouble and if they don't do something about it now, it's going to be a problem, not only for them but also for their family."

Durable Weight Loss Beyond 10 Years

In total, 919 patients had completed more than 10 years of follow-up, and data beyond 10 years were available for 714 patients. The weight loss over time was expressed as the percentage of excess weight loss (EWL), an outcome defined by calculating the excess weight in kilograms above the weight at a BMI of 25 kg/m². At three years, there was 50.5% EWL in 2596 patients, 49.6% EWL at five years in 1983 patients, 47% EWL at 10 years in 714 patients, 47.5% EWL at 12 years in 343 patients, and 47.2% EWL at 15 years in 54 patients. Overall, the mean weight loss for patients followed for more than 10 years was 25.5 kg, a reduction that corresponds to 47% EWL.

Revisional procedures were performed for proximal enlargement (26%), erosion (3.4%), and port and tubing problems (21%). The band was removed in 5.6% of patients. The need to revise the procedure decreased as the gastric-banding technique evolved over time, with a 40% revision rate for proximal gastric enlargement in the first 10 years and a 6.4% revision rate in the past five years. Importantly, the weight loss was similar in patients *****quired a revision.

Systematic Review

In addition to the data from the Center for Obesity Research and Education (CORE) at Monash University, O'Brien and colleagues performed a meta-analysis of all bariatric procedures with 10 or more years of follow-up. Included in the analysis were nine studies of Roux-en-Y gastric bypass, seven studies of adjustable gastric banding, five studies of gastroplasty, and three studies of biliary pancreatic diversion and/or duodenal switch (BPD/DS).

Overall, the weighted mean EWL was 54.2 %, with a range of 33% to 60%. For the bypass studies, the mean EWL was 54.0%, while the EWL was 54.2%, 52.9%, and 73.3% for the gastric banding, gastroplasty, and BPD/DS studies.

O'Brien noted that laparoscopic adjustable gastric banding differs from gastric-bypass procedures in that weight loss with the bypass procedure occurs primarily in the first year. With gastric banding, two to three years are required for peak weight loss. However, at the end of three years, the weight loss curves for both are flat and superimposed on each other. Unlike gastric bypass, however, gastric banding requires long-term follow-up, with at least two visits to the physician per year, something some surgeons might be reluctant to do, so they opt to perform gastric bypass instead.

With the present study, O'Brien said there is no signal of weight gain beyond 10 and 15 years, so there is hope that the weight loss will be durable for two decades or more. With regard to diabetes, he cautioned that while gastric banding and bypass both have a powerful effect on the metabolic disorder, there is nothing known about the long-term effect on diabetes or diabetic complications. Some studies have suggested that as many as half of patients with a remission of diabetes at five years see the disease return. More studies and follow-up are still needed on this aspect of weight-loss surgery, said O'Brien.

The Center for Obesity Research and Education receives an unrestricted grant from Allergan and Allied Medical for research and educational support.

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For comments on this see

http://www.obesityhelp.com/forums/lapband/4599858/15-year-study-of-banding/

Susan,

Excellent study,

And this bring to light where SO many surgeons are pushing other surgeries on patients these days as I always suspected:

Bingo:

"gastric banding requires long-term follow-up, with at least two visits to the physician per year, something some surgeons might be reluctant to do, so they opt to perform gastric bypass instead"

This study hit it dead on the nail, it's NOT the band that causes problems MOST of the time it's SURGEONS not providing the aftercare the lap band NEED, because lap band aftercare CAN get tedious and aggravating if the band is not filled properly and sometimes the band requires tiny, tiny tweaks, of 0.1 ml to get to the sweet spot and MANY surgeons are just NOT WILLING TO DO THIS. Hence why some patients never hit the sweet spot,either too tight or not enough.

So, I am sure many surgeons will push the Bypass and the Sleeve because they really don't require long term followup-- from a surgeon, they can just push them off to their PCP for long term follow-up. You can't push lap band patients to other doctors because it is a specialty that only a band surgeon can handle PROPERLY, if something goes wrong.

I find this statement to be very interesting and VERY TRUE:

"For the bypass studies, the mean EWL was 54.0%, while the EWL was 54.2%, 52.9%, and 73.3% for the gastric banding, gastroplasty, and BPD/DS studies."

If you carefully compare at 10 years the EWL with Banding, -- the Bypass, and Gastroplasty, a restrictive only surgery,  Lap Banders had HIGHER EXCESS WEIGHT LOSS - Bypass at 54.0%, Gastroplasty at 52.9% and Lap Band at 54.2% slightly better than Bypass and slightly lower than Gasrtroplasty at 10 years post op. But of course the DS has the highest long term EWL due to its highly malabsorption component, but that has its own long term risks as well.

I am sure the reason the lap band did better long term than the Bypass was the fact that it CAN ALWAYS BE ADJUSTED, and restriction never goes away, UNLESS there are complications.

Any time you have a weight loss surgery where there is a risk of stretching, or malabsorption going away, it will not be as effective long term.

But I find this study interesting compared to US long term studies which has very Poor long term results of banding, and the US studies that I've read Lap Band long term SUCCESS depends GREATLY on SURGEONS skills and their aftercare practices -- which goes back to my first comment above.

MANY US surgeons get aggravated with providing the ONGOING FOLLOW that the band REQUIRES -- also MANY patients never follow up regularly for optimal results.  Surgeons nowadays will PUSH another surgery type that does not require fills/or much long term follow up, on the patient due to these reasons.

So -- to SUM IT UP ...the success of the lap band GREATLY depends on surgeon skills and fill practices and aftercare and patient willingness to see their surgeon for needed aftercare and of course being compliant.

And I am sure you will get different results from each individual Surgical Practice, I would very leery to have a surgeon operate on me that has a VERY HIGH lap band revision/removal rate, if I was seeking the band.