The long-term data from O'Brien out of Australia was published recently. O'Brien has the advantage of working in a system of single payer- thus- payment for services is never an issue with the band. O'Brien, like all physicians in Australia, is simply paid a salary, he is not paid based on his output or anything other than a simple pay scale. They have great follow up, as well as a great medical record system so people are not lost. Here is the summary from Pub Med - 

 

Ann Surg. 2013 Jan;257(1):87-94. doi: 10.1097/SLA.0b013e31827b6c02.

Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature.

O'Brien PE, MacDonald L, Anderson M, Brennan L, Brown WA.

Source

Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia. [email protected]

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 (26%), erosion (3.4%), and port and tubing problems (21%). The band was explanted 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.

 

This is one of the better papers about the sleeve - for your own interest. This comes from Cleveland Clinic, which is a great group of surgeons with great follow up.

 

Ann Surg. 2012 Aug;256(2):262-5. doi: 10.1097/SLA.0b013e31825fe905.

Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up.

Eid GM, Brethauer S, Mattar SG, Titchner RL, Gourash W, Schauer PR.

Source

Department of Veterans Affairs, Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, USA. [email protected]

Abstract

OBJECTIVES:

In this study, we report long-term outcomes of high-risk, high-BMI (body mass index) patients who underwent laparoscopic sleeve gastrectomy (LSG).

BACKGROUND:

Short- and medium-term data appear to support the effectiveness of LSG, but long-term data to support its durability are sparse.

METHODS:

A prospective database was reviewed on all high-risk patients who underwent LSG as part of a staged approach for surgical treatment of severe obesity between January 2002 and February 2004. We included only patients who did not proceed to second-stage surgery (gastric bypass). Analyzed data included demographics, BMI, comorbidities, and surgical outcomes. All partial gastrectomies were performed using a 50F bougie.

RESULTS:

Seventy-four patients underwent LSG, and follow-up data were available on 69 of 74 patients (93%). The mean age was 50 years (25-78) and the mean number of co-morbidities was 9.6. Perioperative mortality (

Do you have the entire study please?  It is always nice to have all the details when reading a study as you can see with the Monash study.

 

And look at which study he picks!  Check out the target population!!!!!!!!!!!!

In this study, we report long-term outcomes of high-risk, high-BMI (body mass index) patients who underwent laparoscopic sleeve gastrectomy (LSG).

You know, your average run of the mill sleeve patient!  

Perhaps you are unaware, but bands and sleeves are not suggested to very high BMI people for a reason.  DS is suggested to them.

But hey!  Good try!

Sleeves were first used as a first step for large BMI patients to do a DS in two steps. A number did so well that sleeves became a stand alone operation. Many super morbidly obese people had the sleeve - then did so well they didn't need or they refused the second part of the operation.

As for bands- the literature shows that they have good results with high BMI - I will be happy to find that for you if you wish.

In terms of the entire study- you can get that online

I know all that.

I just thought it was interesting that to show average weight loss for sleeves you show the people least likely to do well.  Just another of your interesting slants on reality.

As for good results with bands... there are far more studies showing a lack of good results vs. good results.  Look, I was banded at one time.  I wish the studies were not as they are.  But what you and I wish doesn't make reality.  Sleeves are safer long term with far better weight loss results. 

Here is the entire study and well as a response to it by someone:

Monash Study:

Here is a study done that was clearly bought and paid for by Allergan. This is a great example of how they manipulate words and truth. First you will find their study, word for word. In a response you will find someone who tore that study apart and pointed out what the authors didn't want to point out themselves.

Laparoscopic adjustable gastric banding – lap banding – is a safe and effective long-term strategy for managing obesity, according to the findings of a landmark 15-year follow-up study of patients treated in Australia.

The follow-up study, the longest and most comprehensive yet reported, was published in the Annals of Surgery, and found a significant number of lap band patients maintained an average weight loss of 26 kilograms for more than a decade after their procedure.

Professor Paul O’Brien and colleagues from the Centre for Obesity Research and Education (CORE) at Monash University in Melbourne analysed the results in 3,227 patients who had gastric banding betwee***** when the procedure was first introduced, and 2011. The patients in the study were averaged at 47 years-of-age and 78 per cent were women.

Of those patients, 714 had surgery at least 10 years ago and, on average, had maintained a weight loss of 26 kilograms, or almost half of their excess weight.

The weight loss results were similar for the 54 patients in the study who had undergone treatment at least 15 years ago.

“These results show that when you have a significant problem with obesity, a long-term solution is available,” Professor O’Brien said.

“This surgery is safe and effective, and it has lasting benefits. Substantial weight loss can change the lives of people who are obese – they can be healthier and live longer.”

Professor O’Brien said there were also important ramifications for the control of type 2 diabetes, which was strongly associated with being overweight.

“In obese patients with type 2 diabetes, weight loss after gastric banding can lead to effective control of blood sugar levels without the need for medication in about three-quarters of cases,” Professor O’Brien said.

The patients included in the study had followed the rules of their treating team regarding eating, exercise and activity and committed to returning permanently to the aftercare program.

All the surgery was performed by Professor O’Brien, an international pioneer of the technique, and Associate Professor Wendy Brown, President of the Obesity Surgery Society of Australia and New Zealand (OSSANZ).

There were no deaths associated with the surgery or with any later operations that were needed in about half of the patients. About one in 20 patients had the band removed during the study period.

“In treating a chronic disease such as obesity over a lifetime, it is likely that something will need to be corrected at some time in some patients,” Professor O’Brien said.

“The study shows a marked reduction of revisional procedures with the introduction of the new version of the Lap-Band 6 years ago. Importantly, those who had revisional surgery lost as much weight in the long term as those who did not need it.”

The report also included a comparison of gastric banding – which can be done as a day-surgery procedure – and more invasive types of weight-loss surgery such as gastric bypass that are high risk and require longer hospital stay. The weight loss with gastric banding, and the need for future revisional surgery, was similar to that with gastric bypass.

“Access to weight-loss surgery in Australia remains severely limited for many obese patients as relatively few cases are treated within the public health system. We are working hard to improve access,” Professor O’Brien said.

“We have ample evidence that weight-loss surgery is effective, and it is unfair that half of eligible patients cannot be treated, particularly as it has been shown that gastric banding is a highly cost-effective health care measure. The stigma of obesity, and the assumption that it is the person’s fault, entrenches discrimination against people who could benefit.”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

And a response written by a bariatric nurse:

 

Okay, the study shows they followed 3227 people post banding. Of those only 714 are 10 years or longer post op. Amazing, because I don't know 10 people post op in the US. But let's take a look at those 714.

****Of those patients, 714 had surgery at least 10 years ago and, on average, had maintained a weight loss of 26 kilograms, or almost half of their excess weight.****

That doesn't sound good to me at all. If someone started out at 350# let's say that 150# is their ideal weight. They would lose 200# to get to their ideal weight and regain on the average is more than 50% of what is lost. Let's call it 110# since 100# would be 50%. Is that fair? I have to guess because they decline to provide details of just how much regain these people had. So I am guessing very low. At goal in 10 years they can expect to weigh 260#. Still Morbidly Obese.

****The patients included in the study had followed the rules of their treating team regarding eating, exercise and activity and committed to returning permanently to the aftercare program.****

Now, you realize what this means, right? They excluded everyone that would not make their study look good. Yet they are not providing those numbers. This is probably one of the most poorly written studies I have seen in a long time. No numbers to defend any claims, no statistics, no facts and figures, just their claims, no numbers showing how many people they excluded. There are many people who are physically unable to exercise and they excluded them. Elderly people, people too obese to do anything, someone wheelchair bound. All these types of people are fully able to lose weight. Millions of people get to goal and never exercise a day of their journey. But in this study they were excluded. This is not peer reviewed, it is one person's claims. This is exactly how Allergan pays doctors to do their studies.

****There were no deaths associated with the surgery or with any later operations that were needed in about half of the patients****

I think this is my favorite claim of the entire study. Only half either died or needed another operation. Look at the wording. It's manipulative at best.

****“In treating a chronic disease such as obesity over a lifetime, it is likely that something will need to be corrected at some time in some patients,” Professor O’Brien said.****

So reoperations in banded folks are likely.

****“The study shows a marked reduction of revisional procedures with the introduction of the new version of the Lap-Band 6 years ago. Importantly, those who had revisional surgery lost as much weight in the long term as those who did not need it.”****

So they admit many revisions were done but where are the numbers? I'll tell you where they are, they were excluded from this study. Can't you see that? Read the study for yourself. They excluded anyone that wouldn't make the study appear as they wanted it to. The US has their own paid study makers for Allergan and they do the same thing. Christine Ren and her husband Felding at NYU, the very same surgeons that were sued due to the death of a bander from using unlicensed surgeons in the OR. Yes! This is what Allergan has to resort to, surgeons such as these people.

****The report also included a comparison of gastric banding – which can be done as a day-surgery procedure – and more invasive types of weight-loss surgery such as gastric bypass that are high risk and require longer hospital stay. The weight loss with gastric banding, and the need for future revisional surgery, was similar to that with gastric bypass.****

Here they explain how high risk bypass is yet they admit that bands need just as many revisional surgeries as bypass. They compare their study to bypass but they don't show which bypass study they are comparing to for weight loss and maintenance. That's cheating. It is also manipulative and dishonest. And btw, just how similar was weight loss? They should have exact numbers but they don't.

This is not a study. This is the claim of two individual surgeons who excluded a majority of the people but they won't tell just how many were excluded. This is not peer reviewed because it would never make it through the process, it is missing about 95% of the required data to enter the peer review process. 

And finally, if this was actually a "study" as claimed, it is required to tell the source of the funding. They declined to do this and why, you ask? Because it isn't a study! It's the claim of 2 surgeons in Australia who claim to do lots of bands. Read: Band Mill.

This study does more to defend the claims of those who say the band is dangerous.  

First, note that the revision rate changed as the procedure changed. It changed dramatically.

Second, when you include revisions such as a port or tubing issue- that is much different than a revision for a small bowel obstruction.

Third, long term data at five years with sleeve is about the same as these. 

This is a peer reviewed journal- and the study was reviewed by their peers

I will be asking the author of the study to address some of those issues- but your conclusions about who was excluded are incorrect. 

When you say Band Mill - that is an inflammatory term. These surgeons specialize in the band - that is the operation they are reporting on. They do not get paid more to do a band or a bypass, or a sleeve. They get paid the same. They get a paycheck for being a surgeon - no incentives in it.  

A band mill is not a slam.  It is what it is.  There are band mills, sleeve mills, and bypass mills.  I am unaware of any DS mills.  Yet.

I do not include port or tubing corrections as revisions but many doctors do to artificially increase their revision stats.

The version I have of the study does not appear to be peer reviewed in the least.  It is nothing but a joke.  It does not even contain basic data necessary to be peer reviewed and it does not claim to be peer reviewed.  It's very similar to the US surgeons who are paid to produce Allergan studies to come out the way Allergan wants them.  It is laughable at the very least.

Annals of Surgery is a highly respected peer reviewed journal.