Long term results for the Band

terrysimpson
on 4/24/13 11:10 am - Scottsdale, CA

Really- since you state that- please show the reference. 

 

terrysimpson
on 4/25/13 1:04 pm - Scottsdale, CA

Reprinted version with commens by bariatric surgeons of the O'Brien study:

 

 

The findings of a new study published in Annals of Surgery demonstrate that laparoscopic adjustable gastric banding (Lap-Band) is both a safe and effective long-term strategy for managing obesity. The study followed patients for 15 years after surgery, making it the longest and most comprehensive Lap Band follow-up study yet reported.  Researchers from Monash University examined the results of gastric banding in more than 3200 patients who underwent the procedure betwee***** (when the procedure was first introduced) and 2011. The authors also did a sub analysis of their data for 3 distinct time periods in the evolution of the Lap-Band device and techniques for implantation:

1. Perigastric era (1994-2000) where the surgeon dissected very close to the stomach in order to place the band.

2. Pars flaccida era (2001-2005) where the surgeon dissected along the diaphragm, behind the junction of the esophagus and stomach for band placement.

3. Lap-Band AP (2006-2011) where the new “advanced platform” band was placed, which has preformed creases, holds more volume and is lower pressure than the prior Lap-Bands.

A total of 714 of the patients had surgery 10 or more years ago and maintained an average weight loss of about 57 pounds, or nearly half of their excess weight. They saw similar results in the 54 patients who had received gastric banding at least 15 years ago. All of the patients in the study received treatment from Professor Paul O’Brien, who is an international leader in laparoscopic adjustable gastric banding, and Associate Professor Wendy Brown, President of the Obesity Surgery Society of Australia and New Zealand (OSSANZ).

In terms of safety, there were no deaths associated with the surgery or with any further operations that were later needed in about half of the patients. 5.6% of patients had their band removed during the study period, and this decreased from 9.9% in the first, perigastric era, to just 2.2% in the current, Lap-Band AP era. Similarly, revisional surgery for band slippage or pouch enlargement decreased from 40% to under 7% between the first and third eras. The study authors also note that patients who had revisional surgery lost as much weight in the long-term as those who didn’t require a revision.

In the same paper the authors also included their results of a systematic review of publications of all bariatric procedures with 10 years or more follow-up. They found that all current procedures are associated with greater than 50% excess weight loss on average. The weighted mean at maximum followup for gastric banding was 54.2 % and for gastric bypass it was 54%.

We spoke with Dr George Fielding, a pioneer in Lap Band surgery. He said, “This is the largest long term follow up study on the lap band, by the surgeon from Australia who has done more than anyone to explain the band’s benefits over the last 15 years.” Dr. Fielding has a particularly personal understanding of the benefits of the Lap Band; he underwent Lap Band surgery years ago. “Dr O’Brien did my band 13 years ago, and my weight is stable. I’ve lost 110lbs. The most important part of this study is the demonstration of reduction in need for reoperation over the last few years, due to the change to Pars flaccida technique, the use of bigger, softer bands, and awareness of the need to repair hiatal hernias. O’Brien’s results show that the band can be used, very safely, over a long time.”

Dr. David Voellinger, an expert weight loss surgeon in North Carolina, also spoke with us about the study’s implications. He said, “With the recent controversies surrounding the Lap-Band, this is a very timely review. Dr. O’Brien and his team have comprehensively and positively addressed long-term weight loss with the band and re-operation rate after the band. His sub-analysis by timeline is particularly important as it shows the improvements made over time in both the device and in surgical technique. It also very clearly shows the importance of a dedicated, multi-disciplinary program with understanding of band physiology to obtain lasting success with the Lap-Band.”

Dr. O’Brien concluded that his findings show that “laparoscopic adjustable gastric banding is safe and effective, and has lasting benefits. Significant weight loss can improve the lives of people who are obese and they can be healthier and live longer.” Finally, he noted that weight loss induced by Lap-Band surgery can effectively control diabetes symptoms without the need for medication in about three-quarters of cases. You can read more about how effective weight loss surgery is at resolving type 2 diabetes in obese patients here.

SeriouslyDoubtful
on 4/26/13 6:55 am

Anyone can perform a study of whatever they want.  Studies are skewed and people pick which studies they want to share.  I could more than likely perform a study of people that I know and show a 97% failure due to the lap band.  Further yet, I could also name more people than what is even showing in your study above of over 2,000 patients that have almost died from complications of the lap band.  AND... Do NOT tell me that it is their fault either.
I am such a complication.  I did everything according to the rules.  I had success for the first year, then BAM....  Started off with hiatal hernia, ended up with slipped band, necrotic stomach and gangrene.  A year and a half after major surgery to save my life, I am still having complications on a daily basis.  I have more problems than I ever had just being fat.  I will have to say that this is the ONLY thing that I do regret in my life.  I try to learn from everything and live with no regrets, some days when I am still in severe pain from complications from the lap band, I give in to my regrets.

terrysimpson
on 4/26/13 7:41 am - Scottsdale, CA
No you can't do any study. This is the largest long term study for any weight loss operation.
(deactivated member)
on 4/26/13 7:44 am

And it shows the band in a very very bad light.

And yes, anyone can do a study, doesn't make it truth.

MsBatt
on 4/26/13 9:01 am
On April 24, 2013 at 2:17 PM Pacific Time, terrysimpson wrote:

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 - 

 

 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 PEMacDonald LAnderson MBrennan LBrown 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.

 

 

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).

HUH? So 16 years ago the Band was 15% MORE successful than it was 15 years ago? Oh, way---maybe this means that the other 40 patients had had their Band REMOVED in that one-year interval?

Stephanie M.
on 4/26/13 12:55 pm

All I know is I can't eat. 

 

  6-7-13 band removed. No revision. Facebook  Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

              

pineview01
on 4/26/13 2:38 pm - Davison, MI

angryBig Hug!

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

terrysimpson
on 4/27/13 3:04 am - Scottsdale, CA
I'm sorry. We have found that unfilling a band does not relieve symptoms because there is a bit of a slip and scar tissue below it. Removing the band alone won't fix it the scar tissue has to be lysed.
Stephanie M.
on 4/28/13 2:45 am

Unfilling the band did not help and in the 10 months since, I've developed end stage achalasia with 0 % motility.  I was compliant, did not have a slip and I'm more than a little upset at the time, money and resources we've put towards figuring out WHAT is wrong and WHY.  I don't have underlying disease that could be causing this.  I had zero symptoms pre-band.  I know of several dozen experiencing the SAME complication who had the band.  A couple revised to sleeve and are in real trouble now.

The preop testing, screening for bands needs to be re-thought.  Manometry to eliminate those who might not do well with a high pressure wls will save $$$ in the long run and quality of life can be preserved.

The rule about eating and drinking needs to be rethought.  In Europe and Australia they allow drinking while eating.  Prescribed amounts of 0 calorie liquid does not prevent satiety.  It does prevent damage to the EGJ by reducing pressure.

My discussion with my GI doctor on Monday involved things like "feeding tube", IV hydration, and other unpleasant things. My doctor asked why I'd only lost 5 lb in the last month...my diet; ice cream, and soups made of puréed healthy foods eaten 6-7 times per day.

....there is no celebration of "onderland" for this bandster.  It has come and gone.  My ticker won't reflect my current weight because the weight I'm losing now is due to the devastation to my GI tract.

 

 

  6-7-13 band removed. No revision. Facebook  Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

              

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