So Happy to tell Everyone I choose the Lap-Band and my surgery is coming up!!

Thank you for the information. Please feel free to read my bigger post farther down where I answer some of these questions...thanks again!!

There are two recent studies, both over a 15 year period, which show a removal rate of about 6%. Stroh and Manger 2012 in Europe and the University of Monash 2013 in Melbourne, Australia. Together the two studies cover several thousand people with a very large number being over ten years banded. The manufacturers'  literature no longer talks of a band for life but I have not been able to see a statement of a 5-10 year time span. Can you point me to this? Thanks. 

Here's one, off to find other 

NOTE I fully accept this is Allergan funded. But this is a well known Australian Unversity and I cannot believe they fiddled their figures.

 

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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http://www.monash.edu.au/news/show/gastric-banding-an-effective-long-term-solution-to-obesity

http://www.hindawi.com/journals/jobes/2011/128451/ref/

No, not AGAIN. . I posted this  for the one and only time, on the 19th. 

Yes, I do decline. I have learned long ago that arguments like these are totally pointless. Please stop pestering me.

And the other

 

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Abstract

Background. Gastric banding (GB) is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up. Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome. Results. The mean postoperative follow up time was 94.4 months (range 2–144). The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up. Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

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1. Introduction

Demographic studies worldwide have shown a recent increase in the incidence of morbid obesity, and this condition has been identified as a major public health problem. Nonoperative treatments for weight loss offer limited success and have a high rate of failure. Currently, a Swedish obese subject study has shown that operative treatment of morbid obesity is the only effective therapy [1]. Besides weight reduction, the amelioration of obesity-associated comorbidities is an important consequence of surgical treatment of morbid obesity. Among the variety of restrictive and malabsorptive bariatric procedures, gastric banding has been performed in most countries worldwide. In Germany, GB (besides RYGBP) is the most performed bariatric procedure according to data from a nationwide survey [2].

Because GB has the advantages of being less invasive and a reversible procedure, it has been the procedure of choice for the treatment of morbid obesity for several years in Europe. In 2009, it was the most performed bariatric procedure in the USA.

The aim of our study was to analyze long-term results after GB from 1995 to 2009 and to assess the efficacy of GB for weight loss, improvement of comorbidities, and the incidence of complications.

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2. Materials and Methods

2.1. Patients

Between February 1st 1995 and January 31st 2009, in 200 morbid obese patients, GB was performed at the Municipal Hospital in Gera, Germany. All patients were carefully selected according to IFSO-Guidelines [3].

Data collection was performed prospectively and analyzed retrospectively.

Preoperative characteristics of the patients are listed in Table 1. The operation was performed in 41 (20.5%) men and 159 (79.5%) women with a mean age of 41.5 years. The preoperative BMI was 47.9kg/m². The mean BMI in men was 52.0kg/m², which was significantly higher than in women (46.8kg/m²).

Table 1 Demographic data.

2.2. Operative Technique and Data

Between February 1st 1995 and June 15th 1997, 39 (19.5%) procedures had been performed by one surgeon using open approach technique.

In June 1997, we started the GB procedure with a laparoscopic technique used in 80.5% of operations (Table 2). From June 1997 to February 2001, all Lap Bands were placed using perigastric approach. This technique was used in 68.5% of patients. Conversion rate of laparoscopic technique was 7.4% during the first 100 laparoscopic operations. After introduction of the pars flaccida technique in March 2001, we performed all GB procedures (31.5%) with the pars flaccida technique by a standardized laparoscopic approach to avoid posterior slippage. The space between the left crus and the band was closed to avoid lateral slippage by a stitch between the greater curvature and the left crus. We formed a small pouch of less than 20cc. The pouch was secured by 3 to 5 gastrogastric stitches to avoid anterior slippage.

Table 2 Operation data.

We used 11 SAGB (SAGB; Obtech, Ethicon Endo-Surgery) and 189 Lap-Band bands (INAMED Health, Santa Barbara, CA).

2.3. Postoperative Management

The patients were followed in our hospital. The first consultation and clinical examination was performed six weeks postoperatively and then every three months for the first two years of followup. Followup examinations were performed twice a year or whenever needed after the second postoperative year.

A liquid diet was recommended for the first 5 days postoperatively. A normal diet was introduced thereafter. During each visit, a standardized fup was performed with documentation of weight, eating behavior, and a short clinical examination. Band adjustments were very rare. The band was adjusted only in cases of weight loss less than 2kg per month or a less than 25% change in the EBWL after 3 months. In the case of discomfort from a normal diet or reflux symptoms, the filling of the band was reduced. The injection volume depended on the weight loss and the patient's tolerance as well as his or her eating behaviors.

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3. Results

3.1. Followup

Followup data were available from 83.5% of patients. The mean followup time was 94.4 (6–144) months.

3.2. Slippage

The slippage rate was 2.5% (n = 5). After an open approach in 3 patients, slippage occurred with a mean followup time of 10.3 (1–24) months. After laparoscopy in 2 patients, slippage occurred with a mean followup time of 18 (12–24) months. The operation was performed in all patients in perigastric approach. After introduction of pars flaccida technique, slippage rate decreased to zero.

3.3. Pouch Dilatation (PD)

During the postoperative course, the great majority of our patients developed PD (9.5%,n = 19). A total of 12 patients were operated on by an open technique, and 7 patients underwent a laparoscopic technique. After introduction of the pars flaccida technique, pouch dilatation no longer occurred.

3.4. Band Migration

Band migration occurred in 5.5% (n = 11) of cases. In all patients, the operation was performed using a perigastric placement of the band.

3.5. Band Removal

Band removal was performed in 24 (12%) patients. Five patients wished to have the band removed due to discomfort. In one patient, the band was removed due to her excellent excessive weight loss. In 18 patients, the band had to be removed in case of long-term complications such as band migration in 11 cases and slippage in 2 cases. In 2 cases, the band was removed at an out-of-town hospital without any described reason after a cholecystectomy. Epiphrenic esophageal diverticula, gastric wall necrosis, and acute peritonitis were the reasons for band removal among the other patients (Table 3).

Table 3 Reasons for band removal.

3.6. Reoperation

Among the above-mentioned complications, 61 (30.5%) patients required reoperation. In 5 patients, the band was explanted without any substitution. The total number of patients requiring reoperation was significantly higher in the open approach group (31.3%,n = 43) versus the pars flaccida group (3.2%,n = 3). Data for reoperation are shown in Table 4. The reoperation rate was 2.2% per year.

Table 4 Overall reoperation rate.

3.7. Weight Loss after Gastric Banding

Weight loss after gastric banding is summarized in Table 5.

Table 5 Excess body weight loss in comparison with literature.

3.8. Changes in Comorbidities

During the postoperative period, 85.7% of patients who had previously suffered from diabetes prior to bariatric surgery could significantly reduce their insulin doses. In 14.3% of patients, diabetes was resolved, completely. Amelioration of hypertension was observed in 82.2% of patients.

3.9. Postoperative Mortality

There was no early postoperative mortality.

During the followup period, four patients (3 female and 1 male) died. The mean age of these patients was 64.1 (range 50.5–70) years. Two patients died due to their severe comorbidities 6 months and 96 months after GB. One patient died due to gastric cancer 36 months after GB [4]. Another woman died after repair of an abdominal wall hernia 132 months after band implantation.

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4. Discussion

GB is beside RYGBP the most frequently performed bariatric operation worldwide. According to the data of a meta-analysis study, this procedure has been carried out in 95% of countries performing bariatric surgery [5].

When GB was introduced, the results were excellent in comparison with other restrictive bariatric procedures.

In the literature, only a few prospective randomized studies have been reported. These studies compared GB with RYGBP or/and SG. In addition, randomized trials comparing different kinds of bands (low- and high-pressure bands) were also performed. Single center studies report data with low evidence on the complication rates, outcome, and amelioration of comorbidities. In general, patient's outcome after GB is influenced by the incidence of long-term complications. These include slippage, pouch dilatation, and band migration as well as port-site complications and esophageal dilatation. Nevertheless, there are only a few studies examining long-term results with a time period longer than 10 years available in the literature.

In our clinical experience, the results obtained after 14 years show a high complication rate and a weight regain after the 5th year of followup. These data are comparable with data published by Lanthaler et al. [6]. In their data describing young patients, weight loss was very successful within the first 4 years postoperatively [6]; thereafter, the BMI increased slowly. However, the reason for weight regain after that time was not described in detail. In our experience, most of the patients change their eating behaviors to liquids and sweets leading to a high calorie intake.

Nevertheless, an improvement in obesity-related comorbidities was observed in most patients. However, complete resolution of diabetes was less than reported in a published meta-analysis [4]. Reasons for this difference may have been the high BMI of our patients and the early onset of diabetes prior to surgery.

In our retrospective examination with preoperative data collection, the majority of our patients were female, which is consistent with data from the literature [5, 6]. The BMI (47.5kg/m²) in our patients was higher than in most published studies due to the reimbursement problems of bariatric surgeries in Germany.

4.1. Slippage and Pouch Dilatation

Over time, the complication rates for incidences of slippage and pouch dilatation decreased. The drop in the complication rate was the result of a switch from the perigastric to a pars flaccida technique as well as the introduction of next generation bands and the development of band devices especially made for the connecting tube and the port system.

In fact, there was a decrease in the slippage rate from 3.6% in the perigastric approach to 0% in the pars flaccida technique [7].

Pouch dilatation is a long-term complication after GB. The incidence of pouch dilatation is influenced by the surgical approach (open versus laparoscopic) and the technique (perigastric versus pars flaccida). Opening the lesser sac during open band placement leads to a higher incidence of pouch dilatation than the laparoscopic approach, which creates a small retrogastric channel. Data in the literature examining the incidence of pouch dilatation are mostly heterogeneous because most studies include different approaches and techniques. Otherwise, there are only a few reports with a followup period of more than 5 years.

4.2. Band Migration

Intragastric band migration is characterized by a “silent” migration of the band into the stomach [8, 9]. Peritonitis symptoms are usually absent, and there are limited retrospective data obtained from long-term studies available [10, 11]. The incidence of band migration ranges from 0.6% to 14.4% according to the literature [10–13]. In a few studies, band migration has been considered as a complication associated with the first 2 postoperative years, which is caused by intraoperative gastric perforation [6, 14–16].

In our data, most patients with band migration had an uncritical uptake of nonsteroidal antirheumatic agents, bronchospasmolytic drugs, and anticoagulant substances. Specifically, 26.6% of patients were treated with nonsteroidal antirheumatic substances, 20.2% with anticoagulant substances, and 0.6% with bronchospasmolytic drugs. Therefore, in our opinion, these medications should be considered as potential causes of band migration. Chronic inflammation at the tissue area covered by the band could be a further reason for developing erosion. In our experience, band migration occurs by 30–86 months postoperatively [17]. In addition, the erosion rate has been shown to increase over the long-term followup period [18].

Band erosion can lead to a life-threatening condition in cases of upper gastrointestinal bleeding and bowel obstruction. Therefore, finding a correct diagnosis is essential. In our study, we did not see any port infection in the first 3 postoperative months and after band filling. In the literature, port infection has been reported to be the first symptom of erosion [19]. However, our own data revealed varying intervals between the onset of port infection and the occurrence of erosion.

Thus, the treatment depends on symptomatology. We favor band removal in cases of complete erosion using gastroscopy and an AMI Band Cutter (CJ Medical, Buckinghamshire, Great Britain) [17].

In the literature, a correlation of erosion rate with the band type (high-pressure versus low-pressure bands) has not been described [20].

At the end of the 1990s, repositioning of the band in cases of slippage and pouch dilatation was widely performed. However, data from our study indicated a higher incidence of gastric band migration, and data in the literature have shown disappointing results [17, 18, 21]. Thus, in cases of slippage and pouch dilatation, most published results and our findings reveal no indication for rebanding [18]. We believe band removal in cases of erosion accompanied by a simultaneous “rebanding” should not be performed because there is a potential risk of infection of the new band. This conclusion is based on the different causes of band erosion, a significantly higher migration rate following intraoperative gastric perforation and the currently available data in the literature. In addition, because of the high failure rate after band revision, a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion needs to be considered.

4.3. Amelioration of Comorbidities

According to data from a German nationwide survey on bariatric surgery, our reported patients had a significantly higher age and BMI compared with data obtained in the meta-analysis on bariatric surgery patients [5]. In addition, significantly more patients suffered from type-II diabetes mellitus and arterial hypertension in our study. Thus, the consequential higher rate of comorbidities was due to the occurrence of a severe metabolic syndrome. However, the impact of a high preoperative BMI on weight reduction needs to be investigated through a long-term study.

4.4. Reoperation Rate

The reintervention rate per year of followup in our patients was 2.2%. These data correspond to the literature, which reports a reoperation rate between 3 and 4% per year of followup [18].

4.5. Excess Weight Loss

Concerning the EBWL, the literature reports an EBWL of 47.5% from a meta-analysis study. This meta-analysis reported a progression in weight loss for the first 3 years after GB, which was followed by a stable level of weight loss out to 8 years with no detectable regain of weight [22]. Data of long-term studies with a followup time of more than five years are shown in Table 5. Studies comparing weight loss after perigastric technique to pars flaccida approaches have not shown any influence of operation technique on EWL [23]. GB results in a continuous weight loss during the first 3 years and is sustained for up to 5 years. These results are in concordance with data from the Italian Band Group, but not with weight loss patterns observed in Australian data [14, 23]. We believe the patients in our study had a lower weight loss due to the higher preoperative BMI and the higher incidence of diabetes type II. For better long-term results, we suggest interdisciplinary teamwork to reduce long-term complication rates, increase weight loss, and ameliorate comorbidities.

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5. Conclusion

GB has been shown to be a safe and efficient bariatric procedure when performed by an experienced surgeon using a standardized operation technique. The importance of a close and standardized followup by an experienced multidisciplinary team and the surgeon can result in a decreased complication rate, increased weight loss, and reduced comorbidities.

Furthermore, there are no data in the literature addressing specific criteria, which allow the selection of patients for either restrictive or malabsorptive procedures so as to improve final outcome. To guarantee long-term success after bariatric surgery and to avoid complications, particularly when following combined procedures, lifelong postoperative care is required, which is a specific concern for obesity surgery. Moreover, there is a limited amount of long-term followup data available in the literature and these are from just a few single center studies. Thus, researchers and clinicians should prospectively enroll all patients as indicated by the German multicenter observational study for quality assurance in obesity surgery. This study annually registered parameters such as weight reduction, amelioration of comorbidities, and long-term complications. Subsequently, these data were used to assess the surgical treatment of morbid obesity in Germany [2].

 

 

Welcome to the board. I am by every measure a long term band success story and I know, in real life, many like me. I love my band! It has enabled me to change my life. 

But do be aware that losing with the band is quite hard work and does not suit everyone. Do lots of research into all aspects of banded life. Don't be swayed by just one presentation by a pro-band doc. I am concerned by the speed with which this decision is being made. No surgery guarantees success, all surgery carries risks, all weight loss surgery requires a life style change. Make sure you know what all the involves. 

Did he tell you it can take some people six months to get the right level of restriction and that a few never get it? Did he tell you that we expect to lose 1 or 2 lbs a week! Did he tell you that we can eat round the band? Did he tell you that re-operations are not uncommon- in the UK if is about 10% of people need some sort or repair and for some reason that figure is much higher in the US. Dd he explain that the band should never physically stop you eating, it just dims hunger, unless it is too tight, you can eat more than you should, especially soft foods. 

But having done your research, don't be swayed by online stories! Either my very positive experience or the bad experiences of others. Be convinced by research and by your doctor. Just make sure you really understand what this involves. Here in the UK, I have the security of knowing that if things go wrong, I get free medical care. Make sure just how much aftercare your insurance will give you.

I would be banded again in a heartbeat and have no regrets at all. But it is not an easy option. 

Thank you for your very honest answer and bringing up questions that probably everyone was thinking. Please feel free to read my bigger post on this one where I answer some of those...and again Thanks! Please feel free to share any tips or wisdom you have with me :)

I sense your excitement and that is wonderful, however, you do need to be very prepared that things may not go as well as your surgeon is suggesting.  He hasn't really spoken the truth.  Having fills and unfills anytime you want is not always good.  You really don't want an unfill ever.  Your goal is to just be tight enough to limit your intake and keep you satiated for 4 hours, while keeping you from getting stuck IF you are following the rules of eating the smaller portions and eating small and slow bites.  You don't want your band to be a "choke chain" so you take the slows a month at a time, not more frequently than that, you allow it time to settle and show if restriction is found.  As someone mentioned it can take up to 2 weeks before a fill will even show itself.

 -- Many eat correctly and as mentioned by others do not find their "sweet spot" ever.  Some Banders take as much as 6 months before they even feel they have a tool, others never feel they have a tool.

Please make sure you know the cost of your fills and your unfills.  Even if your insurance covers the surgery, they need to cover the adjustments, both fills and unfills.  Some surgeons charge a very high price - for adjustments.  Mine charged $15.00, but after he retired the new doctor charged 10x that. 

The LapBand worked for me and I was lucky for 4 years and then it didn't work anymore and was causing physical damage to my stomach, the tubing was literally wrapped around my internal organs and I had to have it removed and I revised to the Sleeve.  I wish I had never had the Band, that surgery cost me a lot since I was self pay and my revision cost me more money and  time and another trip to the OR and General Anesthesia. 

Good Luck to you and I truly do hope you lose and have an uncomplicated Band life.