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Study: Long Term Outcomes of Lap Band

So Blessed!
on 4/12/11 8:25 am


http://archsurg.ama-assn.org/cgi/content/short/archsurg.2011 .45


Long-term Outcomes of Laparoscopic Adjustable Gastric Banding

Jacques Himpens, MD; Guy-Bernard Cadičre, MD, PhD; Michel Bazi, MD; Michael Vouche, MD; Benjamin Cadičre, MD; Giovanni Dapri, MD
 

Arch Surg. Published online March 21, 2011. doi:10.1001/archsurg.2011.45

Objective  To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity.
Author Affiliation: The European School of Laparoscopic Surgery, Department of Gastrointestinal Surgery, Saint Pierre University Hospital, Brussels, Belgium.

Design  Clinical assessment in the surgeon's office in 2009 (≥12 years after LAGB).

Setting  University obesity center in Brussels, Belgium.

Patients  A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.

Intervention  Laparoscopic adjustable gastric banding.

Main Outcome Measures  Mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated.

Results  The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral.

Conclusion  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 reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes.

 

Stephanie M.
on 4/12/11 8:31 am, edited 4/12/11 8:32 am
Did you happen to notice the number of patients and dates of this study?? Not to be disrespectful, I am sure you mean well, but the last patients studied were banded 14 years ago! The Pars Flaccida method of fixing the band in place by suturing was adopted in 2000....so this study is completely irrelevant to today's bands and banding surgical technique!

Patients A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.

I don't think there is any benefit in posting this other than to again throw an outdated study out there to scare people away from banding...really bad and transparent attempt...sorry.

 

  6-7-13 band removed. No revision. Facebook  Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

              

So Blessed!
on 4/12/11 8:43 am

By definition the surgeries would have to be old in order for it to be a Long-Term study. 

This was a recent study that I ran across this morning.  since this is a weight loss surgery board, it seemed to be the appropriate place to share it.

If you know anything of my previous posting history, I ALWAYS encourage people to learn about the risks and benefits of every surgery type, including RNY (the one that I had).

MarilynT
on 4/13/11 7:04 am
RNY on 10/02/01 with
By definition the surgeries would have to be old in order for it to be a Long-Term study. 

**************************************************

^^^^^^^^^
This.

Everyone is always lamenting "there are no LONG TERM STUDIES"; then, when one is done it is discounted.

I don't think the OP was "bashing the band"; she was posting information. Use it/believe it/discount it....whatever you want. 

Marilyn (now in NM)
RNY 10/2/01
262(HW)/150-155(GW)/159(CW)
(updated March 2012)

Pumpkin X .
on 4/12/11 9:09 am - Califreakinfornia , CA
On April 12, 2011 at 8:31 AM Pacific Time, Steph M. wrote:
Did you happen to notice the number of patients and dates of this study?? Not to be disrespectful, I am sure you mean well, but the last patients studied were banded 14 years ago! The Pars Flaccida method of fixing the band in place by suturing was adopted in 2000....so this study is completely irrelevant to today's bands and banding surgical technique!

Patients A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.

I don't think there is any benefit in posting this other than to again throw an outdated study out there to scare people away from banding...really bad and transparent attempt...sorry.
You have had your band LESS THEN A YEAR. Please look us up in 14 years and tell us how you are doing. Information is powerful. Being territorial over your surgery choice is like a dog peeing on a tree and marking it's territory
Stephanie M.
on 4/12/11 9:21 am
On April 12, 2011 at 9:09 AM Pacific Time, Pumpkin X . wrote:
On April 12, 2011 at 8:31 AM Pacific Time, Steph M. wrote:
Did you happen to notice the number of patients and dates of this study?? Not to be disrespectful, I am sure you mean well, but the last patients studied were banded 14 years ago! The Pars Flaccida method of fixing the band in place by suturing was adopted in 2000....so this study is completely irrelevant to today's bands and banding surgical technique!

Patients A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.

I don't think there is any benefit in posting this other than to again throw an outdated study out there to scare people away from banding...really bad and transparent attempt...sorry.
You have had your band LESS THEN A YEAR. Please look us up in 14 years and tell us how you are doing. Information is powerful. Being territorial over your surgery choice is like a dog peeing on a tree and marking it's territory
Hey Punkin...back off.  I was simply pointing out that this study taken out of context of all the other studies that are out there is irrelevant and doesn't reflect the surgeries being done today...that is like trying to buy a 2012 Ford based on the 1997 Ford review in consumer reports.  It isn't the same product.
There are other studies out there that are larger and do not support the conclusions of this study.  BTW, I am well aware of all of the "faults" of my band and don't feel the need to encourage anyone to have banding surgery over another type of surgery.  My message to anyone investigating WLS is to encourage them to do their research and make up their own mind based on their needs, medical history and their doctor's recommendation.  I am much to "old" to go around ******g on other peoples "trees"...what do you suppose the purpose of SoBlessed's post was, if not to spread a little RNY "pee" on the lapband "tree"???

 

  6-7-13 band removed. No revision. Facebook  Failed Lapbands and Realize Bands group and WLS-Support for Regain and Revision Group

              

Pumpkin X .
on 4/12/11 9:26 am - Califreakinfornia , CA
MacMadame
on 4/13/11 1:06 pm - Northern, CA
 "There are other studies out there that are larger and do not support the conclusions of this study."

There are plenty of studies out there that *do* support the conclusions of this study. In particular, there are studies that show a reoperation rate of up to 40% in band patients 5 years out. There are plenty of studies showing EWL of around 40-50% as well.

It was the re-operation rate that scared me off from getting a band. I didn't want to have a second operation and I figure, if I was just going to end up with a VSG anyway, why not just get one to start with?

HW - 225 SW - 191 GW - 132 CW - 122
Visit my blog at Fatty Fights Back      Become a Fan on Facebook!
Starting BMI 40-ish or less? Join the LightWeights

Dionysus
on 4/12/11 8:40 am
So Blessed!
on 4/12/11 8:44 am

 You're welcome.
Hermosa L
on 4/12/11 8:57 am
Lap Band on 03/10/09 with
I love my band .. and even if for some reason it had to be removed I wouldn't revise to any other surgery.. my band taught me how to change MY approach to food.... I dont just eat what I want even if it's 5 bites.. I eat food for health .. approx 100 pounds down and still losing..

I credit my band and my good choices
So Blessed!
on 4/12/11 9:00 am

Congratulations on your success.  I've seen several other bandsters on OH that have done extremely well with theirs. 

I hope things continue to go well for you too.
susan24
on 4/12/11 9:37 am - Stuck in traffic or an airport near you, TX

"several"   This made me giggle..considering how many there are on OH.  LMAO.

Oh...nothing like a good surgery war on a slow day




“Saying ‘I’m sorry’ is the same as saying ‘I apologize.’ Except at a funeral.”
-- Demetri Martin

MarilynT
on 4/13/11 7:07 am
RNY on 10/02/01 with
The OP is not turning this into a surgery war; those of you questioning her motives are.

She simply posted a study; and since (as I said before) we are always lamenting the lack of LONG TERM POST OP STUDIES, I think it is valid and perhaps useful information.

And if the OP only comes to the main forum, perhaps "several" successful lapbanders is really all she knows of. That's more than me.....but then again, I don't generally pay attention to the surgery types of posters unless it's relevent to the discussion.

Marilyn (now in NM)
RNY 10/2/01
262(HW)/150-155(GW)/159(CW)
(updated March 2012)

susan24
on 4/13/11 7:22 am - Stuck in traffic or an airport near you, TX
I'm not questioning her motives. I know exactly what her comment meant and it made me laugh. Now as for you- buzz off. Wasn't talking to you. Pull the stick out of your ass and lighten up.



“Saying ‘I’m sorry’ is the same as saying ‘I apologize.’ Except at a funeral.”
-- Demetri Martin

Ms. Cal Culator
on 4/13/11 7:29 am, edited 4/13/11 7:34 am - Tuvalu
On April 13, 2011 at 7:07 AM Pacific Time, MarilynT wrote: The OP is not turning this into a surgery war; those of you questioning her motives are.

She simply posted a study; and since (as I said before) we are always lamenting the lack of LONG TERM POST OP STUDIES, I think it is valid and perhaps useful information.

And if the OP only comes to the main forum, perhaps "several" successful lapbanders is really all she knows of. That's more than me.....but then again, I don't generally pay attention to the surgery types of posters unless it's relevent to the discussion.


Thank you for noticing that "long term studies" require going back in time a bit.  This WAS published in 2011, wasn't it? 

Those WERE pre-FDA approval and the pars flaccida technique has been abandoned...so maybe a study starting around 2001 or so would be more accurate relative today's patients.

I think the deal is...were all of these failures BECAUSE of the pars flaccida technique or were there other factors at play?  A later study might un-confuse that issue.

MARIA F.
on 4/12/11 9:33 am - Athens, GA

Great info, thanks for posting!


~1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands~

Now those are very dismal stats! :-(

 

   FormerlyFluffy.com

 

psychomom
on 4/12/11 4:08 pm - China Grove, NC
Lap Band on 05/10/10 with
(deactivated member)
on 4/12/11 9:44 am - ~Somewhere in~, PA
Surgeons no longer used the SAME method they used over 20 years ago....the slippage rate and erosion rate was TOO HIGH, based on your article findings.

This study is interesting HOWEVER, the patients that they studied HAD THE OLD TECHNOLOGY THAT IS NO LONGER USEDThe PARS FLACCIDA METHOD WAS INTRODUCED DURING THE FDA approval in the UNITED STATES IN 2001, MOST surgeons started using this method widely in 2004. I got my band placed in 2005 and my surgeon used the Pars Flaccida method and so far so GOOD.

A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation. 

When the lap band was new the erosion rate ran as high as 10 percent. This occurred primarily in Australia and Europe because they used the peri-gastric technique. This lower placement of the band caused a higher slippage rate. The solution to that was to stitch the stomach tightly over the band. Any time you have living tissue in contact with something artificial, in this case the lap band the tissue if under too much tension can't get proper blood flow. As the tissue dies, it can't resist the pressure of the band and it erodes into the stomach. Later on the Europeans and Australians realized they were causing the erosion with their technique and changed to the the pars flaccida technique which places the band much higher on the stomach. They also don't wrap the stomach tissue so tightly over the band so the tissue doesn't die and the band won't erode in. The erosion rate is now down to less than 1%.

Most surgeons nowadays use the Pars Flaccida method to securely stitch the band in place in the back and front, and if the patient follow post op diet instructions their bands WILL NOT SLIP.

I am going on 6 years with my original band and so far no slip and no erosion.....hopefully I will go to my grave with it.

 

 

 


So Blessed!
on 4/12/11 10:12 am
Surgeons no longer used the SAME method they used over 20 years ago....the slippage rate and erosion rate was TOO HIGH, based on your article findings.

This study is interesting HOWEVER, the patients that they studied HAD THE OLD TECHNOLOGY THAT IS NO LONGER USEDThe PARS FLACCIDA METHOD WAS INTRODUCED DURING THE FDA approval in the UNITED STATES IN 2001, MOST surgeons started using this method widely in 2004. I got my band placed in 2005 and my surgeon used the Pars Flaccida method and so far so GOOD.


 Thanks for the information, Naomi.