Use of predictive criteria to guide patient selection led to a 50% decline in complications after laparoscopic adjustable gastric banding (LAGB) and improvement in long-term weight loss, a French investigator reported.
The complication rate declined from 19% in an unselected historical control group of LAGB patients to 9% in a selected group of patients. The mean body mass index (BMI) at 5 years was 3 kg/m2 lower in patients selected on the basis of criteria associated with successful weight loss in previous studies of LAGB, Jean-Marc Chevallier, MD, said here at the American Society for Metabolic and Bariatric Surgery.
Rates of reoperation and band removal also declined in the criteria-selected patients, said Chevallier, of Hopital Européen Georges Pompidou in Paris.
"We can conclude, on this prospective series of patients selected on predictive factors of success, that compared with our historical nonselected patients, gastric banding appeared to have a decreased complication rate, a decreased reoperation rate, and a decreased band-removal rate," he said. "This means that it is nowadays useless to publish long-term results with gastric banding compared with the older perigastric technique and older high-pressure bands and on nonselected patients."
LAGB has won favor among bariatric surgeons and their patients because of its overall low morbidity, weight-loss efficacy, and reversibility. However, several studies have demonstrated high rates of late complications, and questions have arisen regarding the long-term durability of weight loss achieved with gastric banding.
Chevallier and colleagues previously examined bariatric surgery outcomes in nationwide data collected by the French National Medical Insurance Service (Ann Surg2007; 246: 1034-1039). They identified five factors associated with increased likelihood of successful weight loss: age <40, BMI <50, patient willingness to change eating habits, physical activity, and surgery by a team with a volume of two or more bariatric procedures a week.
GM Diet
Investigators prospectively evaluated the criteria by using them to select 429 patients for LAGB from January 2005 to December 2010. They compared outcomes against those of an unselected cohort of 1,227 patients treated from December 2002 to January 2003.
Negative Calorie
The criteria-selected patients had a mean age of 39.7, BMI of 41.60, weight of 252 lb., and follow-up of 29.24 months (and for as long as 5 years).
Bariatric Surgery
A total of 35 complications (a rate of 9%) occurred among the criteria-selected patients: 11 cases of band slippage, four cases of food intolerance, esophageal dilation in four patients, two intragastric migrations, and 14 port-related problems. Additionally, 20 patients (5.1%) required reoperation, and band removal was required in 12 patients (3%).
The historical cohort had an overall complication rate of 19.2% (P<0.001 versus selected patients), reoperation rate of 21% (P<0.001), and a band-removal rate of 10% (P<0.001).
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