The finding regarding gastric banding comes on the heels of a recent study out of the University of California, San Francisco that suggested gastric bypass surgery is superior to alternative surgical methods (such as gastric banding AKA Lap-band) for promoting weight loss and/or eliminating type 2 diabetes.
The current observations stem from a research effort led by Dr. Jacques Himpens, of the European School of Laparoscopic Surgery at the Saint Pierre University Hospital in Brussels, whose team assessed the status of 82 patients that had undergone the procedure known as "laparoscopic adjustable gastric banding" (lap-band) more than a decade prior to the study.
Himpens and his colleagues outline their findings in the March 21 online issue and the July print issue of the Archives of Surgery.
Laparoscopic Adjustable Gastric Banding, AKA Lap-Band
Laparoscopic adjustable gastric banding creates a small pouch by placing a constricting ring, or band, around the top portion of the stomach; the smaller stomach size allows patients to feel full more quickly.
Since its introduction in 2001, the laparoscopic adjustable gastric banding approach has become a popular alternative to "Roux-en-Y gastric by-pass" surgery, which involves the literal stapling of the stomach in order to redirect food past part of the small intestine to instigate reduced food absorption as well as a quicker sensation of satiety.
Laparoscopic Adjustable Gastric Banding Safety Under Fire
But laparoscopic adjustable gastric banding surgery has come under criticism in the past for involving a relatively high risk for health complications, including injury to the spleen and esophagus, wound infection and a poor prognosis in terms of long-term quality of life. It is also been reported that laparoscopic adjustable gastric banding surgery patients are likely to regain much of their lost weight.
Laparoscopic Adjustable Gastric Banding Success Studied
To explore satisfaction levels and the long-term complication history of gastric banding, in 2009 the researchers examined a pool of patients who had undergone laparoscopic adjustable gastric banding surgery between 1994 and 1997.
The results: 12 years or more later, more than 60% of the banding patients said they were "satisfied" with their experience. On average, excess weight loss had been maintained at a level approaching nearly 43%, and quality of life appeared to be equal to that of patients who had not undergone laparoscopic adjustable gastric banding surgery.
However, 39% of the patients who underwent laparoscopic adjustable gastric banding surgery had experienced serious health complications, including abnormal pouch expansion (9), band erosion (23) and band infection (1). Another 22% experienced relatively minor health complications. Almost 50% of the patients who underwent laparoscopic adjustable gastric banding surgery had to have the bands entirely removed, while 60% needed to undergo subsequent surgery. The laparoscopic adjustable gastric banding surgery procedure "appears to result in relatively poor long-term outcomes," the researchers concluded.
One in six of the patients who underwent laparoscopic adjustable gastric banding surgery ended up deciding to have a gastric bypass procedure, and all of these patients demonstrated good outcomes following their subsequent surgery.
Himpens said that patients should limit their expectations with respect to gastric banding, noting that "all weight-loss operations have a high failure rate". But he added that "it is still defendable for surgeons to continue doing this [laparoscopic adjustable gastric banding surgery]."
"The high failure rate of the band gastroplasty [in] the long term is not that much worse than other procedures," he noted. "[I] therefore think patients will continue to ask for the procedure [laparoscopic adjustable gastric banding surgery]."
But he cautioned that patients undergoing band surgery should do so knowing that they need to commit themselves to rigorous long-term follow-up.
Laparoscopic Adjustable Gastric Banding Awareness Needed
Meanwhile, in a critique published alongside Himpens work, Dr. Clifford W. Deveney, a professor of surgery in the department of surgery at Oregon Health and Science University in Portland, concluded that the current study on laparoscopic adjustable gastric banding surgery does "not shed a favorable light on the use of laparoscopic adjustable gastric banding surgery ".
"The laparoscopic adjustable gastric band has a spotty history," Deveney said. "Some groups have very good results, with 60 to 70% weight loss. But other groups [of the patients who underwent laparoscopic adjustable gastric banding surgery] have either poor weight loss or [health] complications, or both."
"So I think," he continued, "that the patient should be made aware of these facts, and also that the weight loss is going to be less with the band than with a gastric bypass. And that it'll take longer to achieve the weight loss, because with gastric bypass most of the weight loss occurs over the first year, while with a gastric band it takes five to six years."
"It's also easier to 'cheat' on the gastric band," he added. "You can eat around the band and render it ineffective if you're not disciplined in following a healthy diet. With gastric bypass that's not as much of an issue. But all this is not to say that I think we shouldn't be doing laparoscopic adjustable gastric banding. It's just not as good as gastric bypass."
- March 21, 2011, Archives of Surgery, online;
- Jacques Himpens, M.D., European School of Laparoscopic Surgery, Saint Pierre University Hospital, Brussels, Belgium;
- Clifford W. Deveney, M.D., professor, surgery, department of surgery, Oregon Health and Science University, Portland