As weight loss surgery gains popularity globally, there is much debate as to which of the several surgeries available is the best option. As we get more years of experience under our belts (so to speak), it seems that laparascopic adjustable gastric banding may be a poor choice of surgery over the long term.
A study was published last week in the Archives of Surgery by Dr J Himpens and colleagues, examining the long term outcomes of lap banding. This study comes out of Saint Pierre University Hospital in Belgium, which is the first site to ever perform the procedure in 1992.
With a long term follow up of 12 years or more, the study found the average excess body weight loss with laparscopic adjustable gastric banding was 43%, though this varied greatly from person to person (excess body weight is defined as the amount of weight OVER a Body Mass Index of 25 that a person carries, so in other words, they found that patients lost an average of 43% of the total amount of body weight that they would need to lose in order to get to a ‘normal’ body weight).
In terms of complications, they found that 22% of patients experienced minor complications (such as infection of the access port or incisional hernia) from their lap band, while 39% experienced major complications (such as erosion of the band through the wall of the stomach, or slippage of the band). Sixty percent required at least one additional operation (often to fix a complication), and 17% percent of patients had their procedure switched to gastric bypass surgery (a more complicated weight loss procedure where the stomach is made permanently smaller, and the intestines are rerouted such that food bypasses the first 1.5m of small intestine). Only 51% of patients still had their band in place at the 12+ year mark. Having said the above, the majority of patients still rated their satisfaction with the band as good, though there was no overall change in quality of life scores.
In terms of obesity related complications, one in particular that I found interesting is their observations in regards to diabetes. Over the shorter term (eg 2 years), data suggest that weight loss surgery is dramatically effective to put many cases of diabetes into remission. In this study, they found that while only 5 of their patients had type 2 diabetes before surgery, 11 of them had type 2 diabetes at the 12 year follow up. While it is very possible (and probably likely) that more of these patients would have developed diabetes had they not had the surgery, I think the point is that weight loss surgery should not be considered a lifetime ‘cure’ or prevention of diabetes, though it can certainly provide some disease-free years or lessen the severity of the disease. I would also point out that more complex bariatric surgery procedures such as gastric bypass are superior to banding in their effect on diabetes, though cases of diabetes are often shown to recur over the long term post bypass as well.
This study is subject to several limitations, including the fact that they were only able to follow up with just over half of the patients that were contacted for full evaluation. Newer techniques for lap banding are now currently being utilized that may have lower complication rates than the methods used 12+ years ago. Successes, failures, and complication rates may differ from centre to centre as well. However, this is the first study exploring outcomes of lap banding after more than 10 years post surgery, so they are important and must be taken into consideration. This study, and other experiences accumulating around the world, is likely to lean surgeons away from performing lap band surgeries.
Dr Sue Pedersen www.drsue.ca © 2011 firstname.lastname@example.org
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