ABSTRACT
BACKGROUND: Vertical banded gastroplasty (VBG) has been in clinical use since 1979 and adjustable gastric banding (AGB) since 1985. Because promising results were achieved with the adjustable gastric bands available in the market, some surgeons came to the conclusion that VBG might be entirely abandoned and replaced by the adjustable gastric band. The aim of this study was to compare the long-term outcome of the 2 restrictive procedures. METHODS: Within a 7-year period (1994-2001), 1117 gastric restrictive procedures were performed in the course of a prospective nonrandomized comparative trial. We report the outcomes of 563 VBG and 554 AGB procedures performed by 2 surgeons. The mean body mass index was 46.9 +/- 09.9 kg/m(2) for VBG and 46.7 +/- 07.8 kg/m(2) for AGB. Patient selection was performed by acceptance by 1 of the 2 surgeons. VBG was performed by laparotomy and AGB using laparoscopy. The Bariatric Analysis and Reporting Outcome System (BAROS) was used to evaluate the postoperative health status and quality of life. RESULTS: The mean duration of follow-up was 92 months (range 60-134), with a minimum of 5 years. The overall follow-up rate was 92%. In the short-term 3-year follow-up, no statistically significant difference was registered between AGB and VBG in terms of weight loss, reduction of co-morbidities, or improvement in quality of life. The 30-day mortality rate was .4% (2 patients) for VBG and .2% (1 patient) for AGB. The overall reintervention rate in the long term was 49.7% for VBG and 8.6% for AGB (P <.0001, odds ratio .0937, 95% confidence interval .065-.133), the reoperation rate was 39.9% for VBG and 7.5% for AGB (P <.0001). The excess weight loss was significantly greater in the VBG group after 12 months (58% for VBG versus 42% for AGB, P <.05). At long-term follow-up (mean 92 months), no significant difference in weight loss was registered between the 2 study groups (59% for VBG and 62% for AGB, P = .923). The BAROS score in the short term (3 years) was good to excellent in 94% and 90% of the VBG and AGB groups, respectively. In the long-term follow-up period, the BAROS score was significantly in favor of the AGB group (83.9% versus 57.8%, P <.0001, odds ratio 3.797, 95% confidence interval 2.072-7.125). The overall resolution rate of co-morbidities was 80% in both groups. CONCLUSION: This long-term follow-up study shows that VBG and AGB are effective restrictive procedures to achieve weight loss, and loss of co-morbidities. A statistically significant lower re-intervention and re-operation rate and an improved health status and quality of life were registered for AGB.
Subject(s)
Gastroplasty/methods , Obesity, Morbid/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
OBJECT: To determine if a 6-month regimen of prophylactic ursodeoxycholic acid is effective in the prevention of gallstones. SUMMARY BACKGROUND DATA: Rapid weight loss after surgery for the treatment of morbid obesity is associated with a high incidence of gallstone formation. METHODS: Patients with vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB) were enrolled in this study. A single-center, randomized, double-blind, prospective trial evaluated 500 mg of ursodeoxycholic acid versus placebo, beginning within 3 days after surgery and continuing for 6 months or until gallstone development, for patients with morbid obesity. Transabdominal sonography or abdominal CT scan was obtained preoperatively at 3, 6, 12, and 24 months after surgery or until gallstone formation. RESULTS: From March 1997 to April 2000, 262 patients were submitted to surgery. Seventy-seven patients refused to participate in the study; 43 patients with previous gallstone operation or verified gallstones preoperatively were excluded. Of 152 patients, 76 were randomized to placebo and 76 to 500 mg of ursodeoxycholic acid daily. Preoperative age, sex, weight, BMI, and postoperative weight loss were not significantly different between groups. Gallstone formation was significantly less (P = 0.0018, Fisher exact test) frequent with ursodeoxycholic acid than with placebo at 12 months, 3% versus 22%, and 8% versus 30% (P = 0.0022) at 24 months, cholecystectomy in 4.7% versus 12%, respectively (P < 0,02, Fisher exact test). CONCLUSION: A daily dose of 500 mg of ursodeoxycholic acid for 6 months is effective prophylaxis for gallstone formation following gastric restrictive procedures.
