Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity.

BACKGROUND: Many studies of short-term to mid-term outcomes after laparoscopic adjustable gastric banding (LAGB) have been published, but reliable long-term outcome reports with a minimum follow up ≥ 10 years in a sufficient number of included patients are still scarce. The objective of this study was to evaluate the long-term results after LAGB. METHODS: Sixty consecutive patients (44 women, 16 men) were treated for morbid obesity by LAGB between 1996 and 1999. Median age of the patients at the time of operation was 45 years (range 21-64). Median preoperative body mass index (BMI, kg/m(2)) was 45 (range 35-55). All patients were asked to adhere to a strict follow-up program. Patients' BMI and percentage excess weight loss (%EWL) were calculated in the hospital's database for bariatric patients, and excess weight was taken as the weight in kilograms above the weight at BMI of 25 kg/m(2). RESULTS: Complete data on all 60 patients could be assessed; thus, the overall rate of follow-up was 100%. After a median (range) follow-up of 14.1 years (13.2-16.8 years), the mean BMI (SD) dropped from 45 (5) to 36 (6) kg/m(2), with a mean (SD) EWL of 49% (29). At 15 years of follow-up, 29 (48%) bands have been removed, and 38 (63%) reoperations have been performed in 29 (48%) patients. Almost 70% received further treatment for their morbid obesity after band removal. Of those patients with the band still in place at 14 years, 40% had more than 50% EWL and 20% had less than 25% EWL. There was no mortality related to the primary or revisional operations, but 2 patients died of unrelated causes. CONCLUSIONS: Mean %EWL after LAGB after more than 14 years was fairly good-49%. However, a reoperation rate of more than 60% in 48% of the patients and a band removal rate of almost 50% may indicate that LAGB cannot be recommended as a primary procedure to the general morbidly obese population.

SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results.

BACKGROUND: The long-term efficacy of laparoscopic Roux-en-Y gastric bypass (RYGB) in the treatment of morbid obesity has been demonstrated. Laparoscopic sleeve gastrectomy (SG) as a single procedure has shown promising short-term results, but the long-term efficacy of SG has not yet been demonstrated. The aim of this study was to determine the preliminary 30-day morbidity and mortality of RYGB and SG in a prospective multicenter randomized setting. METHODS: A total of 240 morbidly obese (BMI = 35-66 kg/m²) patients evaluated by a multidisciplinary team were randomized to undergo either RYGB or SG. There were 117 patients in the RYGB group and 121 in the SG group; two patients had to be excluded after randomization. Both study groups were comparable regarding age, gender, BMI, and comorbidities. RESULTS: There was no 30-day mortality. The median operating time was significantly shorter in the SG group (66 min vs. 94 min, p < 0.001). All complications were recorded thoroughly. There were 7 (5.8 %) major complications following SG and 11 (9.4 %) after RYGB (p = 0.292). Nine (7.4 %) SG patients and 20 (17.1 %) RYGB patients had minor complications (p = 0.023). The overall morbidity was 13.2 % after SG and 26.5 % after RYGB (p = 0.010). There were three (2.5 %) early reoperations after SG and four (3.3 %) after RYGB (p = 0.719). CONCLUSIONS: At 30-day analysis SG is associated with a shorter operating time and fewer early minor complications compared to RYGB. There were no significant differences in major complications or early reoperations. Long-term follow-up is required to determine the effect on weight loss, resolution of obesity-related comorbidities, and improvement of quality of life.

11-year experience with laparoscopic adjustable gastric banding for morbid obesity--what happened to the first 123 patients?

BACKGROUND: Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up. METHODS: Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60-132). EWL < 25% or major reoperation was considered as a failure. EWL > 50% was considered a success. RESULTS: Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21-44). Mean (range) preoperative weight was 130 kg (92-191). Mean (range) preoperative body mass index was 49.28 kg/m2 (35.01-66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years. CONCLUSIONS: Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.

Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux?

BACKGROUND: Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published. METHODS: A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 +/- 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy. RESULTS: Total number of reflux episodes decreased from a mean value of 44.6 +/- 23.7 SD preoperatively to 22.9 +/- 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% +/- 6.2% to 3.5% +/- 3.7%, P=0.0009, and DeMeester score decreased from 38.5 +/- 24.9 to 18.6 +/- 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 +/- 5.46 to 38.4 +/- 6.45 (P<0.0001), excess weight from 60.0 kg +/- 18.58 kg, 44.9% +/- 6.56% to 38.4 kg +/- 20.27 kg, 28.4% +/- 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. CONCLUSIONS: The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.

Impact of laparoscopic adjustable gastric banding for morbid obesity on disease-specific and health-related quality of life.

BACKGROUND: Health-related quality of life (HRQoL) in Finnish morbidly obese individuals was compared with that of Finnish age norms and prospectively with the HRQoL and the disease-specific quality of life (QoL) at 12 months, and cross-sectionally at 28 months, following laparoscopic adjustable gastric banding, mainly with the Swedish band. METHODS: The Moorehead-Ardelt questionnaire was used for disease-specific QoL assessments in 95 patients preoperatively, in 52 patients prospectively followed-up to 12 months, and cross-sectionally in 52 patients operated at a median of 28 months earlier. A generic 15-dimensional questionnaire was used for HRQoL-measurements in 75 patients preoperatively, and 34 patients have been followed-up to 12 months. HRQoL outcomes were compared cross-sectionally with the 52 patients operated at a median of 28 months earlier. RESULTS: Disease-specific QoL scores were significantly improved on all domains of the Moorehead-Ardelt questionnaire 12 months after surgical treatment, an improvement maintained at a median of 28 months follow-up. Significant improvements in generic HRQoL scores were seen on the dimensions mobility, respiratory function, sleep, the performance of usual acts, vitality and sexuality 12 months after surgery. Significant worsening was seen on the eating dimension. Of these dimensions, mobility and sleeping were not significantly improved at a median of 28 months follow-up, and scores on the eating dimension were not significantly worse compared with values obtained in the preoperative group. HRQoL single index score was significantly improved 12 months after surgery. This improvement did not correlate with the extent of weight loss. CONCLUSION: Disease-specific QoL was significantly improved at 12 months follow-up, an improvement that seems to have been maintained at a median of 28 months following operation. HRQol was significantly improved 12 months after the operation. There may be a decline in the improvements after that.

Quality of life following laparoscopic adjustable gastric banding - the Swedish band and the Moorehead-Ardelt questionnaire.

BACKGROUND: Although weight loss is an important immediate outcome after gastric banding operations, quality of life (QOL) has been shown to be an equally important outcome measure. METHODS: From 1996 to May 2002, 125 consecutive patients have been operated laparoscopically for morbid obesity at our institution with the Swedish Adjustable Gastric Band (SAGB). We compared the Moorehead-Ardelt QOL scores of the first 60 patients, operated at a median of 2 years earlier, with a group consisting of the following consecutive 65 patients, who answered the questionnaire preoperatively. RESULTS: The QOL scores among the operated patients were significantly better (P<0.0001, unpaired t-test) on all domains of the Moorehead-Ardelt questionnaire compared to those not yet operated. CONCLUSIONS: Laparoscopic banding with the SAGB has been a safe procedure, with satisfactory weight loss and significant improvement in QOL scores 2 years postoperatively.

Intermediate results following laparoscopic adjustable gastric banding for morbid obesity.

BACKGROUND/AIMS: Morbid obesity is a rapidly increasing health risk in most industrialized countries. Unfortunately, conservative treatment methods will fail in the long run in almost 100% of patients. Today, long-lasting success can only be achieved by operative treatments. Laparoscopic gastric banding has the general benefits of minimally invasive techniques is relatively easy to perform and can be reversed or changed to any other operation aiming at weight loss, if necessary. We report here our primary and intermediate outcome of Laparoscopic Adjustable Gastric Banding (LAGB). METHODS: Since 1996-2001 we have treated 110 (87 women, 23 men) morbidly obese patients with the Swedish Adjustable Gastric Band (SAGB). Median age (range) of the patients was 42 years (21-64), and preoperative median body mass index (BMI, kg/m(2)) (range) was 44 (35-66). Most of the patients suffered from obesity related co-morbidities. RESULTS: At a median follow-up of 27 months, mean weight loss was 30 kg, mean excess weight loss (range) 52% (11-108%), and median (range) BMI 34 (24-46). Reoperations due to band slippage (3 patients), band erosion (2 patients), infection (1 patient), and leakage of the band or the filling system (5 patients) have been necessary in 11 (10%) patients so far. Median postoperative hospital stay (range) was 3 days (2-53). There was no mortality. Immediate postoperative morbidity was 9%. More than 50% of the patients had signs of mild erosive gastroesophageal reflux disease during routine endoscopic follow-up 3 years after the operation. CONCLUSION: Weight loss following LAGB is generally good and complications few, at least in the short term. However, technical problems with the band causes morbidity and reoperations in a number of patients. Despite this fact, we think the LAGB operation is the best 'first' operation in the treatment of morbid obesity, although long-term results are not yet available.