Lap Band: Long term Studies

Abandon Gastric Banding Bariatric Surgery, Say Experts
Kate Johnson


July 16, 2012 (San Diego, California) — Bariatric surgeons should abandon gastric banding in favor of sleeve
gastrectomy or gastric bypass procedures, several researchers reported here at the American Society for Metabolic
and Bariatric Surgery 29th Annual Meeting.

In the United States, the use of gastric banding is still "peaking," but elsewhere in the world it has largely fallen out
of favor, said Michel Gagner, MD, in an interview with Medscape Medical News.

Dr. Gagner, from Hôpital du Sacré-Coeur in Montreal, Quebec, Canada, is a world-renowned bariatric surgeon who
has established several bariatric surgery centers of excellence in the United States. He said he has virtually
abandoned gastric banding, and performs sleeve gastrectomy in 90% of his cases.
His approach matches that of Luigi Angrisani, MD, director of the general and laparoscopic surgery unit at Giovanni
Bosco Hospital in Naples, Italy.

Dr. Angrisani presented 10-year follow-up data from a prospective randomized trial comparing gastric bypass with
banding, and said the evidence is clearly in favor of bypass.

Europeans are ahead of the game, having started banding procedures before North America, and therefore
detecting problems earlier, said Dr. Angrisani. "This is a very common story. While we as Europeans accept the
messages from the US world of surgery, the US community does not accept data coming from Europe. So they are
now living the experience we had in the last few years."

"It's a complete disaster, when you think that banding in the United States, based on the BOLD data, is the
second-most common procedure," said Dr. Gagner. "Europeans are abandoning banding and the Americans are not
getting the message. This abandonment that we see in Europe — we are probably going to see this in the next few
years in the United States."

Allergan drop plans for adolescent Lap-­‐Bands

Thursday, October 4, 2012 - 08:56
Pete Myall: Online editor, BariatricNews
Allergan have confirmed that they have abandoned plans to market their Lap-Band gastric band to obese adolescents in the US, bringing to an end a seven-­‐year application process.
The announcement comes as Allergan struggles to protect its market share for their device, facing increasing scepticism from the medical community about the efficacy of gastric bands.
In an August earnings call, Allergan CEO David Pyott said that the results were due both to a shrinking  bariatric market, and a decline in the number  of gastric band operations performed in the USA.

A recent series of  studies have also questioned the device’s safety and efficacy. A 2011 study investigating the Long- term  outcomes of  laparoscopic adjustable gastric banding, published in the Archives of Surgery,  found that 48.6% of the participants needed their bands removed,and excess weight loss was  42.8%at 12years. A  recently-­‐published10-­‐year study found  that bypass patients were likely to losemore weight and keep it off for longer than band patients. Another  recently published six-year case-matched study reported  that Rouxen-‐Y gastric bypass is associated with better weight loss, resulting in a better correction of  some comorbidities than gastric banding.

Allergan also face criticism  in America from Congress. SomeDemocrats  have  called  for hearings  into whether the FDA failed  to protect the  public from the risks associated with the Lap-­‐Band, combined with aggressive and misleading marketing from some providers.

Reporting on the results of an international survey into surgery trends, American bariatric surgeon Henry Buchwald recently said that he thought  the gastric band procedure would “more or less disappear” in the near future.

High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity
Eric J. DeMaria, MD, Harvey J. Sugerman, MD, Jill G. Meador, RN, BSN, James M. Doty, MD, John M. Kellum, MD, Luke Wolfe, MS, Richard A. Szucs, MD, and Mary Ann Turner, MD
ANNALS OF SURGERY Vol. 233, No. 6, 809–818

To report the results from one of the eight original U.S. centers performing laparoscopic adjustable silicone gastric banding (LASGB), a new minimally invasive surgical technique for
treatment of morbid obesity.

The authors did not find LASGB to be an effective procedure for the surgical treatment of morbid obesity. Complications after LASGB include esophageal dilatation, band leakage,
infection, erosion, and slippage. Inadequate weight loss is common, particularly in African American patients. More study is required to determine the long-term efficacy of the LASGB.

Long-Term Results of a Prospective Study on Laparoscopic Adjustable Gastric Banding for Morbid Obesity
Y. Van Nieuwenhove &W. Ceelen & A. Stockman & H. Vanommeslaeghe & E. Snoeck & K. Van Renterghem & D. Van de Putte & P. Pattyn
OBES SURG (2011) 21:582–587

The objective of this study was to study the long-term outcome of adjustable gastric banding in the treatment of morbid obesity. In Europe, the preference for gastric band has declined in favor of Roux-Y-gastric bypass.

After LAGB, band removal was necessary for complications or insufficient weight loss in 24% of patients. Nearly half of the patients achieved a more than 50% EWL, but in 88%, a more than 10% EWL was observed. LAGB can achieve an acceptable weight loss in some patients, but the failure in  one out of four patients does not allow proposing it as a first-line option for the treatment of obesity.

Safety and effectiveness of bariatric surgery: Roux-en-Y gastric bypass is superior to gastric banding in the management of morbidly obese patients.
Ulrich Guller*1,2, Lazar V Klein1 and John A Hagen1
Patient Safety in Surgery 2009, 3:10

The use of bariatric surgery in the management of morbid obesity is rapidly increasing. The two most frequently performed procedures are laparoscopic Roux-en-Y bypass and laparoscopic gastric banding. The objective of this short overview is to provide a critical appraisal of the most relevant scientific evidence comparing laparoscopic gastric banding versus
laparoscopic Roux-en-Y bypass in the treatment of morbidly obese patients.

Results and discussion:
There is mounting and convincing evidence that laparoscopic gastric banding is suboptimal at best in the management of morbid obesity. Although short-term morbidity is low and hospital length of stay is short, the rates of long-term complications and band removals are high, and failure to lose weight after laparoscopic gastric banding is prevalent.

The placement of a gastric band appears to be a disservice to many morbidly obese
patients and therefore, in the current culture of evidence based medicine, the prevalent use of
laparoscopic gastric banding can no longer be justified. Based on the current scientific literature,
the laparoscopic gastric bypass should be considered the treatment of choice in the management of morbidly obese patients.

Long-term Outcomes of Laparoscopic Adjustable Gastric Banding
Jacques Himpens, MD; Guy-Bernard Cadière, MD, PhD; Michel Bazi, MD; Michael Vouche, MD; Benjamin Cadière, MD; Giovanni Dapri, MD
ARCH SURG/VOL 146 (NO. 7), JULY 2011. pp802-7


To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity.

Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a re-operation rate of 60%), LAGB appears to result in relatively poor long-term outcomes.

A 10-year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates
M. Suter, MD, PD, FACS1,2; J. M. Calmes, MD2; A. Paroz, MD2;V. Giusti, MD
Obesity Surgery, 16, 829-835. 2006.

Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of choice for morbid obesity. Few long-term studies have been published.We present our results after up to 8 years (mean 74 months) of follow-up.

LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material.Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate.With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.