Medium and long-term results of gastric banding: outcomes from a large private clinic in UK

Abstract

BackgroundLaparoscopic adjustable gastric band (LAGB) has been an established bariatric procedure for the last three decades and was, for many years, the first-choice procedure for the treatment of chronic obesity. However, more recently, the popularity of the LAGB has been in sharp decline and has been replaced by other procedures such as the Roux-En-Y gastric bypass and sleeve gastrectomy. A key driver in this decline has been the high revision and early explanation rates reported in some studies.MethodsThis was a retrospective study of 2246 patients who underwent LAGB at a large private clinic in the UK between June 2004 and October 2014.Results2246 patients were included in the study; 1945 (84.6%) were women. All patients were followed up for 2 years following their procedure and subsequent follow up was at the discretion of patients. Mean follow up duration was 43.7 +/− 29.3 months. Operative mortality was zero and there were no in-hospital returns to theatre. Mean preoperative weight and body mass index (BMI) were 111.2 ± 22.1 kg and 39.9 ± 6.7 kg/m2 respectively. Mean excess % BMI loss at 1-, 2-, 5- and 8-years of follow-up was 43.1 ± 25.4, 47.9 ± 31.9, 52.4 ± 41.7 and 57.1% ± 28.6 respectively. There was no significant difference in mean excess % BMI loss between those < 50 or ≥ 50 years old (p value = 0.23) or between patients with an initial BMI of < or ≥ 50 kg/m2 (p value = 0.65). Complications over nine years occurred in 130 (5.8%) patients and included: 39 (1.7%) slippage or pouch dilatation, 2 (0.04%) erosions and 76 (3.4%) problems related to the access port or LAGB tubing. The overall re-operation rate for LAGB complications was 4.2% over 9 years with a LAGB explantation rate of 1.5%. 39 LAGBs were converted to a sleeve or gastric bypass procedure, 11 of these due to complications.ConclusionThis is the first study to report on LAGB outcomes from a private clinic in the UK. LAGB is a safe procedure, which delivers significant and durable weight loss with acceptable complications rates and low re-operation rate.

Bioring® gastric banding for obesity in a private South African hospital

“…His band eroded at 2 years. This compares with Niville et al who documented a 1.66% erosion rate in a Lap-Band ® series, 61 and with 0.04% in the Bioring ® series of Giet et al 57 An outlier Lap-Band erosion prevalence of 33% was reported by Himpens et al 37 We attribute our low erosion prevalence to the low pressure exerted on the gastric wall and the bellows-like action on inflation of the Bioring ® band. 17 Increasing age, super-super obese status, and suboptimal aftercare were identified as predictors of failure.…”

“…This is a liberal definition, which to a degree likely explains the high prevalence in this series compared with that of Giet et al who reported a mere 1.7% slippage rate. 57 Most (34 of 40, 85%) slippage patients in this series came to secondary surgery. Thirty-two slipped bands were removed, and 2 were revised.…”

Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement

“…Critiques of banding include the potential for the band to erode into the stomach, band slippage/migration, dilation of the esophagus, and insufficient weight loss. In the Giet et al long-term study, overall rate of reoperation for LAGB complications was 4.2% over 9 years and explant rate was 1.5% [133]. complication rate and successful use in correctly selected and well-supported patients.…”

“…In a 2018 study of 2246 obese patients, weight loss at 5 and 8 years was durable, with 52.4 ± 41.7 and 57.1 ± 28.6% mean EBMIL, respectively[133]. In a 2017 study of 89 morbidly obese patients, metabolic syndrome resolution occurred in 60/89 patients (67.0%) at 12 months following LAGB and in 60/75(80.…”

The metabolic benefits of different bariatric operations: what procedure to choose?

“…Although there have been studies demonstrating high rates of complications requiring reoperation or revision which support this view, the experience in high-volume centres with a regular follow-up would suggest that better outcomes are achievable. A retrospective study of more than 2000 patients reported a reoperation rate of 4.5% over a 9-year follow-up period with removal required in only 1.5% of cases (31). In all areas of surgery but perhaps in bariatric surgery more so than any other, careful, considered patient selection and subsequent follow-up are critical to the success of a procedure, a fact illustrated by the broad experience with AGB.…”