Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg

From the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia.
Annals of surgery (Impact Factor: 8.33). 01/2013; 257(1):87-94. DOI: 10.1097/SLA.0b013e31827b6c02
Source: PubMed


: To describe the long-term outcomes after laparoscopic adjustable gastric banding (LAGB) and compare these with the published literature on bariatric surgery.
: Because obesity is a chronic disease, any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective. Yet for bariatric surgery, few long-term weight loss data are available. We report our 15-year follow-up data after LAGB and provide a systematic review of the peer-reviewed literature for weight loss at 10 years or more after bariatric surgical procedures.
: We performed a prospective longitudinal cohort study of LAGB patients using an electronic database system (LapBase) to track progress, measure weight changes, and document revisional procedures. The evolution of the LAGB procedure was recognized, and revisional rates for 3 separate periods between September 1994 and December 2011 were described. In addition, we performed a systematic review of the peer-reviewed published literature collecting all reports that included weight loss data at or beyond 10 years.
: A total of 3227 patients, with a mean age of 47 years and a mean body mass index of 43.8 kg/m, were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. Follow-up was intact in 81% of patients overall and 78% of those beyond 10 years. There was no perioperative mortality for the primary placement or for any revisional procedures. There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. Revisional procedures were performed for proximal enlargement (26%), erosion (3.4%), and port and tubing problems (21%). The band was explanted in 5.6%. The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years. The revision group showed a similar weight loss to the overall group beyond 10 years. The systematic review of all bariatric procedures with 10 or more years of follow-up showed greater than 50% EWL for all current procedures. The weighted mean at maximum follow-up for LAGB was 54.2% EWL and for Roux-en-Y gastric bypass was 54.0% EWL.
: The LAGB study from 1 center demonstrates a durable weight loss with 47% EWL maintained to 15 years. This weight loss occurred regardless of whether any revisional procedures were needed. A systematic review shows substantial and similar long-term weight losses for LAGB and other bariatric procedures.

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    • "Revisional bariatric surgery comprises 5%-15% of total cases of bariatric surgery [3,4,5]. The rate of revisional surgery is 20%-60% after LAGB [6,7,8,9,10,11], 9%-17% after RYGB [6,10,12,13], and 9%-11% after SG [14,15]. Although many articles have investigated the results of various bariatric procedures used as the initial surgical intervention for morbid obesity, studies addressing the proper revisional surgery of choice after failed primary surgery remain limited. "
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    ABSTRACT: Purpose Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center. Methods A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surgery between January 2008 and August 2013. The causes, surgical outcomes, and efficacy of the revisional surgeries were analyzed. Results Twenty-two revisional surgeries were performed laparoscopically during the study period (13 laparoscopic adjustable gastric banding, 9 laparoscopic sleeve gastrectomy). The most common indication for revision was weight regain or insufficient weight loss (12/23, 52.2%), and Roux-en-Y gastric bypass (RYGB) was the most commonly performed secondary procedure (17/23, 73.9%, including four resectional RYGB procedures). Gastric pouch leak occurred in one patient following revisional RYGB, which required reoperation on the first postoperative day. The mean body mass index decreased from 35.9 to 28.8 kg/m2 at a mean follow-up period of 10 months after revision. The percent excess weight losses at 1, 3, 6, and 12 months postoperatively were 18.8%, 41.1%, 40.1%, and 47.4%, respectively. Conclusion Revisional bariatric surgery can be successfully performed via a laparoscopic approach with acceptable risk. Deliberate selection for the proper revisional procedure can efficiently manage undesirable results from the primary surgery.
    Annals of Surgical Treatment and Research 06/2014; 86(6):295-301. DOI:10.4174/astr.2014.86.6.295
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    • "Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgery method used to help obese patients to lose weight. A recent systematic review showed the long term efficacy of this approach [1]: the review demonstrated a durable weight loss with 47% excess weight loss maintained to 15 years. However, even if LAGB is able to produce a durable and relevant weight loss, it is less effective in improving body image: a common problem after bariatric surgery is that patients remain unhappy about their weight, despite a successful treatment. "
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    ABSTRACT: Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgery method used to help obese patients to lose weight. However, even if LAGB is able to produce a durable and relevant weight loss, it is less effective in improving body image: as demonstrated by a recent study, obese patients with a body image disorder in the pre-operative stage continue to show this even 13 months after the operation. In this presentation we will discuss the possible role of virtual reality (VR) in addressing this problem within an integrated cognitive behavioral approach. To test this approach, a case series of three LAGB patient who experienced body dissatisfaction even after a >30/40% excess body weight loss, is presented and discussed. At the end of the 6-week protocol the patients experienced a 15%-20% further reduction of their weight. This reduction was also matched by a general improvement of the psychological state. Both the weight loss and the level of well-being were further improved after a three-month follow-up.
    Studies in health technology and informatics 04/2014; 196:43-7. DOI:10.3233/978-1-61499-375-9-43
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    • "The LAGB provides a profound mechanical effect to restrict food intake, as the band is placed to allow food intake of about a cup of dry food [30]. The LAGB procedure results in approximately 50% of excess body weight loss at 2 years [31]. "
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    ABSTRACT: Substantial heterogeneity exists in weight loss trajectories amongst patients following bariatric surgery. Hormonal factors are postulated to be amongst the contributors to the variation seen. Several hormones involved in hunger, satiety, and energy balance are affected by bariatric surgery, with the alteration in hormonal milieu varying by procedure. Limited research has been conducted to examine potential hormonal mediators of weight loss failure or recidivism following bariatric surgery. While hormonal factors that influence weight loss success following gastric banding have not been identified, data suggest that hormonal factors may be involved in modulating weight loss success following gastric bypass. There may be hormonal mediators involved in determining the weight trajectory following sleeve gastrectomy, though the extremely limited data currently available prohibits definitive conclusions from being drawn. There is great need for future research studies to explore this knowledge gap, as improving this knowledge base could be of benefit to guide clinicians toward understanding the hormonal contributors to a patient's postoperative weight loss failure or recidivism or perhaps be of value in selecting the most appropriate bariatric procedure based on the preoperative hormone milieu. Integrative interdisciplinary approaches exploring these complex interrelationships could potentially increase the explanatory power of such investigations.
    Gastroenterology Research and Practice 10/2013; 2013(8):528450. DOI:10.1155/2013/528450 · 1.75 Impact Factor
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