Past, present, and future: Critical analysis of use of gastric bands in obese patients

Abstract

Adjustable gastric banding (AGB) is quickly becoming the most popular bariatric operation performed in the United States and Canada. Patients are particularly fond of the simplicity of the tool, the relatively low morbidity of the surgery, the quick recovery, and overall results. The gastric band has evolved over its 35-year history into a very successful adjustable tool used to restrict food consumption and limit caloric intake. The percent of excessive weight loss after banding can range from 30%-60% and depends on the time out from surgery. Along with weight loss, there is good resolution of the co-morbid conditions that are associated with excess weight and improvements in quality of life demonstrated after banding. Nutrition and follow up are extremely important after banding to ensure good compliance and adequate weight loss. Failure to follow the postoperative diet, exercise regiment, or mechanical failure of the band can lead to failure to lose adequate weight. While there are particular early and late complications associated with this surgery, the safety profile of the AGB is very appealing when compared to other bariatric operations. As we continue to reduce the morbidity of the procedure, the simple adjustable band concept has a lot of potential to remain a primary technique of maintaining long term weight loss. In conclusion, AGB has and continues to play an important role in the treatment of morbid obesity. It offers reasonably good weight loss results with very little morbidity, and the future of the adjustable band is bright.

Erosion of Gastric Band Tubing Presenting as Port-Site Cellulitis

“…An overall devicerelated complication rate of 12-48% with a reoperation rate ranging from 10 -34% has been reported in the literature. 6 Other series have reported that 40 -50% of band recipients undergo additional surgery over the 10-year follow-up period. 1,5 Aarts et al 12 published a study of 201 patients who underwent LAGB, of which 53% had the band removed or converted to another bariatric surgery approach because of insufficient weight loss or complications.…”

“…11 Various studies reviewing the long-term outcomes up to 10 -15 years after LAGB demonstrate disappointing excess weight loss, weight regain, and reappearance of obesity-related conditions. Snyder et al 6 showed that the failure to achieve a satisfactory excessive weight loss in the first several years after surgery range from 10 -20% with an even greater failure rate occurring when evaluated long-term. Likewise, multiple studies have reported better long-term weight loss and resolution of comorbidities with other bariatric procedures 6,7 when compared to LAGB.…”

“…Band erosion may be considered one of the more serious complications of LAGB, with an incidence ranging from 1 to 3%. 6 Although most erosions occur where the gastric wall is in contact with the band, erosion of the connection tubing into the intestine and neighboring structures, such as the colon, celiac axis, and renal hilum, is a much rarer, yet reported complication. [13][14][15][16][17][18][19] Most authors report a median time of 12-24 months from band placement to erosion, but it may occur more than 10 years after LAGB placement.…”

“…[1][2][3][4] In addition to suboptimal results, long-term follow-up has shown that the LAGB is associated with device-related complications, including band slippage, erosion, dilation of the gastric pouch or esophagus, band and port leaks, and infection. Studies reveal a 12-48% complication rate, 5,6 with up to 50% of patients with the band requiring reoperation at 10 years. 1,5 Erosion is recognized as one of the most serious complications after LAGB.…”

Initial Body Mass Index on Weight Loss Among Obese Filipino Adults Who Underwent Laparoscopic Adjustable Gastric Banding: A Cohort Study

“…4,5 In our institution, it is the most commonly performed bariatric procedure. 6,7 However, LAGB and other purely restrictive operations result in lower-than-expected average weight loss, higher weight regain and less resolution of comorbidities, compared to malabsorptive surgical procedures, exemplified by gastric bypass and biliopancreatic diversion (BPD).…”