Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid (Grade 3) Obesity and its Metabolic Complications: A Three-Year Study

Abstract

Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 +/- 0.83 yr; body mass index (BMI), 44.9 +/- 0.53 kg/m(2); normal glucose tolerance (NGT; n = 77); impaired glucose tolerance (IGT; n = 47); type 2 diabetes mellitus (T2DM; n = 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and high-density lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 +/- 1.11 yr; BMI, 43.6 +/- 0.46 kg/m(2); NGT, n = 66; IGT, n = 8; T2DM, n = 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.

The effect of a rapid weight loss induced by laparoscopic adjustable gastric banding on arterial stiffness, metabolic and inflammatory parameters in patients with morbid obesity

“…However, the most impressive decrease in BMI was observed after 3 months of surgery. 13,14 In our study, at 4 months after surgery, the subjects' weight may not have reached a steady state and their metabolism might not reflect their weight stabilization.…”

“…Laparoscopic adjustable gastric banding has been proven effective in inducing a significant and persistent weight loss, reduction of arterial blood pressure (BP), and improved glucose and lipid metabolism. 13,14 The procedure is performed under general anesthesia and is completely reversible. Laparoscopic adjustable gastric banding is now regularly applied in a few European centers and has recently been approved by the Food and Drug Administration in the United States.…”

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

“…Weight loss was 28-76 kg after 2 y, [79][80][81][82][83][84][85][86][87][88][89] 17-73 kg after 3 y, [79][80][81][86][87][88][89] and 20 kg after 8 y in one study [82][83][84] based on a completers method of analysis. No study reported the proportion of subjects with Z5% weight loss, although this was probably high given the absolute weight loss with surgical therapy.…”

“…Three studies had a followup of at least 4 y. 80,[82][83][84]89 The proportion of subjects lost to follow-up varied widely (5-42%), but was reported only in three studies. One study had a control group of 'usual care'.…”

Increased levels of the Akt-specific phosphatase PH domain leucine-rich repeat protein phosphatase (PHLPP)-1 in obese participants are associated with insulin resistance

“…In 12 of the 82 participants with morbid obesity, tissue samples of rectus abdominis skeletal muscle were obtained during LAGB. Patients with morbid obesity were eligible for LAGB if they fulfilled the following criteria: age 18-66 years; BMI greater than 40 kg/m 2 or greater than 35.0 kg/m 2 in the presence of co-morbidities [39]; and history of at least two previous attempts to lose weight with dietary and medical measures followed by relapse of obesity. Exclusion criteria were: obesity secondary to endocrinopathies (Cushing's disease or syndrome, hypothyroidism), gastrointestinal inflammatory diseases, risk of upper gastrointestinal bleeding, pregnancy, alcohol or drug addiction, and previous or current malignancies.…”