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A Prospective Randomized Study Between

Laparoscopic Gastric Banding and Laparoscopic

Isolated Sleeve Gastrectomy:

Results after 1 and 3 Years

Jacques Himpens, MD; Giovanni Dapri, MD; Guy Bernard Cadière,MD, PhD

Department of Gastrointestinal and Obesity Surgery, European School of Laparoscopic Surgery,

Saint-Pierre University Hospital, Brussels, Belgium

Background: Laparoscopic adjustable gastric banding (GB) is the most popular restrictive procedure for obesity in Europe. Isolated sleeve gastrectomy (SG), is less common, but more invasive and with a higher learning curve. The aim of this prospective randomized study was to compare the results of GB and SG after 1 and 3 years of surgery.

Methods: 80 patient candidates for laparoscopic restrictive surgery were operated consecutively and randomly, between January and December 31, 2002, by GB (7M, 33F) or by SG (9M, 31F) (NS). Median age was 36 (20-61) for GB versus 40 (22-65) for SG (NS).

Median BMI was 37 (30-47) for GB versus 39 (30-53) for SG (NS). After 1 and 3 years: weight loss, feeling of hunger, sweet eating, gastroesophageal reflux disease (GERD), complications and re-operations were recorded in both groups.

Results: Median weight loss after 1 year was 14 kg (-5 to +38) for GB and 26 kg (0 to 46) for SG (P<0.0001); and after 3 years was 17 kg (0 to 40) for GB and 29.5 kg (1 to 48) for SG (P<0.0001). Median decrease in BMI after 1 year was 15.5 kg/m2 (5 to 39) after GB and 25 kg/m2 (0 to 45) after SG (P<0.0001); and after 3 years was 18 kg/m2 (0 to 39) after GB and 27.5 kg/m2 (0 to 48) after SG (P=0.0004). Median %EWL at 1 year was 41.4% (-11.8 to +130.5) after GB and 57.7% (0 to 125.5) after SG (P=0.0004); and at 3 years was 48% (0 to 124.8) after GB and 66% (-3.1 to +152.4) after SG (P=0.0025). Loss of feeling of hunger after 1 year was registered in 42.5% of patients with GB and in 75% of patients with SG (P=0.003); and after 3 years in 2.9% of patients with GB and 46.7% of patients with SG (P<0.0001). Loss of craving for sweets after 1 year was achieved in 35% of patients with GB and 50% of patients with SG (NS); and after 3 years in 2.9% of patients with GB and 23% of patients with SG (NS). GERD appeared de novo after 1 year in 8.8% of patients with GB and 21.8% of patients with SG (NS); and after 3 years in 20.5% of patients with GB and 3.1% of patients with SG (NS). Postoperative complications requiring re-operation were necessary for 2 patients after SG. Late complications requiring re-operation after GB included 3 pouch dilations treated by band removal in 2 and 1 laparoscopic conversion to Roux-en-Y gastric bypass (RYGBP), 1 gastric erosion treated by conversion to RYGBP, and 3 disconnections of the system treated by reconnection. Inefficacy affected 2 patients after GB, treated by conversion into RYGBP and 2 patients after SG treated by conversion to duodenal switch.

Conclusion: Weight loss and loss of feeling of hunger after 1 year and 3 years are better after SG than GB. GERD is more frequent at 1 year after SG and at 3 years after GB. The number of re-operations is important in both groups, but the severity of complications appears higher in SG.

Trina, We are seeing close to 60% excess weight loss at 6 months with sleeve.  It takes our band patients about 2 years to lose that much.  So the band is definitely slower.  However it's also a lower risk operation.  I wouldn't hold your breath on insurance coverage for sleeve in 6 months.

Hey Dr. Curry! I'm Dr. C's (Cirangle) One week old patient. I just wanted to let you know that I think it's great that you check out the board once in awhile.   I LOVE MY SLEEVE!   

Thats exactly why I would rather have VSG in stead of the band... I don't want to have to worry about going back in for surgery to have it removed someday if something goes wrong with it. 

Who said it was fraud and why?  Was it the timing of the surgeries?  Or the fact that you were having a removal at the same time. I would imagine if you want to self pay a sleeve, it wouldn't be fraud if it wasn't being done at the same time as the band removal.   My sleeve was done at the same time as the band, and I DID get the band.   If it is fraud, I was unaware, and I doubt my doctor would have risked his relationship with the insurance companies and his reputation by doing fraudulent procedures.

Many of us arrived at the VSG decision for the very reasons you mention.  For me it wasn't just the hassle of getting fills.  I have had many medical problems the past 1 1/2 years including 2 surgeries and several other intrusive procedures.  My therapist raised the concern that so much body intrusion might not be healthy for me psychologically and when I thought about it I realized that for me she was correct.  I also know a lot of people who lost and regained with lap Band, or had complications such as erosion, slippage, etc.  Since I have been so sick so often I decided I could not risk that complication.  Finally, I know people who have been successful with RNY and Lap, and those who cheat and either regain or cause themselves problems.  I am known as an excellent judge of character (personally and professionally) , yet I can neither predict who will or will not be successful with the traditional surgeries, nor which group I would fall into.  I feared I could end up in denial, fooling myself, sneaking the wrong foods etc. I decided that VSG minimized my ability to play head games with myself and my body as well as the post surgical risks of the other procedures.  Its a HUGE and scary decision to permanently alter a vital organ such as the stomach (someone I know who had lap band actually called it body mutilation which I found highly offensive); but one week out I am convinced it was the right decision for me.

Never give up! Some people have been successful with insuance, but its a long hard fight.  If your husband is a disabled veteran, I wonder if there may be a veteran's group or even a VA hospital associated with a civilian hospital which could be of help with this!  Meanwhile, try saving bits at a time.  There is a huge variability in the cost of surgery depending on where you have it.  Some people even finance it like you would another major purchase.  This is your life and health at stake, AND just think of all the money you will save on food. (Come to think of it, the food saving thing may not count considering you will need a new wardrobe. ) Anyway,  don't give up...keep hoping.... trying...and maybe look at creative options.

I have Kaiser, and they surprised me by saying they'll cover my sleeve if my surgeon agrees it's right for me.   I was originally told they'd only cover Lap band and bypass, but then one of the clinics they use brought in a new surgeon who does the sleeve, and suddenly the story changed.  So do your homework, see if there's a surgeon in your provider network who does the sleeve, and then try to see that surgeon and be prepared to make your case with your insurance.  Lisa

Someone posted a study on here a bit ago...It stated that the long term success rates were better with the sleeve than with the band after 3 and 5 years out.  Wish I could remember who posted it, but I can't...Sorry.

I just turned 43 in February!!  I hope to be back around 130 by the time I turn 45.  I am going to the Bariatric center tomorrow so I am going to see what they say about the VSG..... the surgeon I am using does them.  If only I could get him to come up with a reason that I need that instead of the band!!! .  I will definitely have to work on that.!!  Keep me posted on how you are doing!!