Obesity Surgery, 17, pp-pp
Background: This study examines 1,791 consecutive
laparoscopic adjustable gastric banding (LAGB) procedures
with up to 12 years follow-up. Long-term results
of LAGB with a high follow-up rate are not common.
Methods: Between September 1993 and December
2005, 1,791 consecutive patients (75.1% women, mean
age 38.7 years, mean weight 127.7 ± 24 kg, mean BMI
46.2 ± 7.7) underwent LAGB by the same surgical
team. Perigastric dissection was used in 77.8% of the
patients, while subsequently pars flaccida was used in
21.5% and a mixed approach in 0.8%. Data were analyzed
according to co-morbidities, conversion, shortand
long-term complications and weight loss.
Fluoroscopy-guided band adjustments were performed
and patients received intensive follow-up. The
effects of LAGB on life expectancy were measured in
a case/control study involving 821 surgically-treated
patients versus 821 treated by medical therapy.
Results: Most common baseline co-morbidities (%)
were hypertension (35.6), osteoarthritis (57.8), diabetes
(22), dyslipidemia (27.1), sleep apnea syndrome
(31.4), depression (21.2), sweet eating (22.5) and binge
eating (18.5). Conversion to open was 1.7%: due to
technical difficulties (1.2) and due to intraoperative
complications (0.5).Together with the re-positioning of
the band, additional surgery was performed in 11.9%
of the patients: hiatal hernia repair (2.4), cholecystectomy
(7.8) and other procedures (1.7). There was no
mortality. Reoperation was required in 106 patients
(5.9%): band removal 55 (3.7%), band repositioning 50
(2.7 %), and other 1 (0.05 %). Port-related complications
occurred in 200 patietns (11.2%). 41 patients
(2.3%) underwent further surgery due to unsatisfactory
results: removal of the band in 12 (0.7%), biliopancreatic
diversion in 5 (0.27%) and a biliopancreatic
diversion with gastric preservation (“bandinaro”) in 24
(1.3%). Weight in kg was 103.7 ± 21.6, 102.5 ± 22.5,
105.0 ± 23.6, 106.8 ± 24.3, 103.3 ± 26.2 and 101.4 ± 27.1
at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same
intervals was 37.7 ± 7.1, 37.2 ± 7.2, 38.1 ± 7.6, 38.5 ±
7.9, 37.5 ± 8.5 and 37.7 ± 9.1. The case/control study
found a statistically significant difference in survival in
favor of the surgically-treated group.
Conclusions: LAGB can achieve effective, safe and
stable long-term weight loss. In experienced hands,
the complication rate is low. Follow-up is paramount.
Key words: Morbid obesity, laparoscopy, adjustable gastric
banding, intragastric balloon, bariatric surgery, longterm
outcome
Introduction
Laparoscopic adjustable gastric banding (LAGB)
with the Lap-Band® is the most commonly performed
surgical procedure for morbid obesity in
Europe, Australia and South America.1 Since FDA
approval in 2001, the Lap-Band® has ranked second
among all bariatric procedures performed in the
U.S,1 and, to date, approximately 300,000 of these
procedures have been performed worldwide. Shortand
medium-term series have found the band to be
both safe and effective. However, a paucity of large
long-term follow-up studies has created uncertainty
Laparoscopic Adjustable Gastric Banding in 1,791
Consecutive Obese Patients: 12-Year Results
Franco Favretti; Gianni Segato; David Ashton1; Luca Busetto2; Maurizio
De Luca; Marco Mazza2; Andrea Ceoloni; Oscar Banzato; Elisa Calo2;
Giuliano Enzi2
Department of Surgery, Regional Hospital - Vicenza, Italy (Director Franco Favretti); 2Obesity Unit,
Department of Medical and Surgical Sciences, University of Padua, Italy (Director Giuliano Enzi);
1The Healthier Weight Centre, Princess Grace Hospital, London, UK (Director David Ashton)
Presented at the 11th World Congress of the International
Federation for the Surgery of Obesity, Sydney, Australia,
September 1, 2006.
Correspondence to: Franco Favretti, MD, Contrà Chioare n. 13,
36100 Vicenza Italy. Fax: (+39) 0444 752482; e-mail: ffavret@tin.it
Favretti 1/17/07 4:13 PM Page 1
Property of Springer Media (Obesity Surgery). Not for posting, reproduction or distribution.
in some about the Lap-Band®’s efficacy over time.
This paper reports the long-term outcomes of a very
large group of Lap-Band® patients.
Materials and Methods
From September 1993 through December 2005,
1,791 consecutive patients underwent LAGB surgery
for morbid obesity at our institutions (Obesity
Centers of Vicenza Regional Hospital and Padova
University) (Table 1). All operations were performed
by the same team of surgeons utilizing the
Lap-Band® (Inamed/Allergan), Santa Barbara, CA,
USA) and all patients met the eligibility criteria for
bariatric surgery according to the NIH Consensus
Conference Statement of 1991.2
Outcomes measured over 12 years included mortality,
complications, weight loss and resolution/improvement
of co-morbidities. Life expectancy was evaluated
in an adjunct study of LAGB vs medical therapy.
Preoperatively-recorded characteristics of 1,345
female (75.1%) and 446 male (24.9%) patients
were: mean age 38.7 ± 10.9 years, mean height 1.66
± 0.09 meters, mean weight 127.7 ± 24.3 kg, and
mean BMI 46.2 ± 7.7.
Baseline co-morbidities were present in 71% of
our patients: 57.8% suffered from osteoarthritis,
35.6% hypertension, 31.4% obstructive sleep apnea
syndrome (OSAS), 27.1% dyslipidemia, 22.0%
type II diabetes, 21.2% depression, 9.3% hyperuricemia,
8.7% gallstones, 4.9% amenorrhea, and
1.4% heart failure.
Out of 1,791 patients, 125 (7%) underwent preoperative
application of a Bioenterics Intragastric
Balloon (BIB) with the aim of reducing the surgical
risk. Their mean age was 44.8 ± 11.8 years, mean
height 1.68 ± 0.10 meters, mean weight 161.4 ±
30.1 kg and mean BMI 56.8 ± 9.1.
The perigastric dissection, as has been previously
described,3 was performed in 1,393 patients
(77.8%), the pars flaccida technique was subsequently
used in 384 (21.5%) and the combined
approach5 in 14 (0.8%). Table 1 shows the number
of operations performed per year.
Patients were followed at 1, 3, 6, and 12 months
postoperatively and yearly thereafter. All data concerning
mortality, complications, reoperations,
weight loss and co-morbidities were recorded during
the follow-up visits. Band adjustments were performed
with barium swallow under fluoroscopy.
The co-morbilities were specifically investigated in
830 consecutive patients, consisting of 647 women
(77.9%) and 183 men (22.1%), from September 1993
until November 2005.6 For this group of patients, a
complete cardiovascular risk factor profile was collected
both before and 12 to 18 months after surgery
(mean follow-up time: 15.3 ± 2.1 months).
The effects of gastric banding surgery on life
expectancy were measured in a case/control study
of 821 patients from our Lap-Band® series com-
Favretti et al
2 Obesity Surgery, 17, 2007
Table 1. Number of operations per year and follow-up rate (mean follow-up: 91%)
Year No. of operations Total Follow-up No. of Patients Follow-up
Years Follow-up Rate
1993 4 4 12 4 100%
1994 18 22 11 22 100%
1995 59 81 10 74 91.3%
1996 129 210 9 188 89.5%
1997 130 340 8 311 91.4%
1998 143 483 7 415 85.9%
1999 168 651 6 588 90.3%
2000 192 843 5 765 90.7%
2001 133 976 4 895 91.7%
2002 143 1119 3 1001 89.4%
2003 201 1320 2 1198 90.7%
2004 198 1515 1 1381 90.9.1%
2005 273 1791 – – –
Favretti 1/17/07 4:13 PM Page 2
pared with 821 patients treated by medical therapy
in other Italian medical centers included in the
Multi-site Cohort of the Italian Study Group on
Morbid Obesity7 (Figure 1).
Results
The follow-up rate at 12 years was 91%. The conversion
rate was 1.7%, of which 1.2% was due to technical
problems such as difficult perigastric dissection
and giant left liver lobe hypertrophy, and 0.5% was
caused by intraoperative complications such gastric
perforation and bleeding. There was no surgical mortality
in our entire series of 1,791 patients.
The 125/1791 patients who had a BIB applied
preoperatively lost 24.7 ± 11.7 kg, 8.7 points of
BMI, and a %EWL of 27.9 ± 11.8 at time of Lap-
Band® placement. This group of patients showed the
same conversion and intraoperative complication
rate as the rest of the series.
Major complications requiring reoperation
occurred in 106 patients (5.9%). These included
stomach slippage and pouch dilatation in 70 patients
(3.9%) (band removed in 20 patients – 1.1%, repositioned
in 50 patients – 2.8%), erosion in 16
patients (0.9%) (band removed), psychological
intolerance in 14 patients (0.7%) (band removed),
miscellaneous (HIV, infection, mircroperforation) in
5 patients (0.27%) (band removed) and gastric
necrosis in 1 (0.05%) patient (gastrectomy performed)
(Table 2). If we exclude the 31 major complications
of the learning curve period (first 100
patients), the complication rate is reduced to 4.4%.
Of the 41 patients (2.3 %) with unsatisfactory
results, the band was removed in 12 (0.7%). A classical
biliopancreatic diversion (BPD) was performed
in 5 (0.27%), and a BPD with gastric preservation
(“bandinaro”) was done in 24 (1.3%) (Table 2).
Minor complications requiring reoperation
occurred at the port-site in 200 patients (11.2%).
The port was substituted in 182 (10.2%), repositioned
in 9 (0.5%) and removed in 9 (0.5%). These
port issues, almost entirely related to the port-tubing
transition, were more common early in our experience.
With refinements to the placement technique
and design improvements, these complications have
been largely eliminated.
Weight loss (kg, BMI, %EWL) for the entire
series is shown in Table 3 and in Figures 2, 3 and 4.
At 10 years, the average weight was 101.4 ± 27.1 kg
(loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5
points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ²49) and superobese
(BMI ³50) were separated into two groups for
evaluation/comparison and weight loss in terms of
kg and BMI is reported in Table 4 and shown in
Figures 5 and 6. At 10 years the weight of the morbidly
obese group was 94.6 ± 18.0 kg of the superobese
group and was 123.2 ± 38.5 kg, indicating
weight losses of 23.8 kg and 29.6 kg, respectively.
At 10 years, the BMI in the morbidly obese group
was 35.2 ± 5.4 and in the super-obese group was 44.9
± 13.9, down 7.4 and 11.3 points, respectively. The
%EWL in the morbidly and super-obese groups is
reported in Table 5 and shown in Figure 7. At 10 years,
%EWL was 40.3 ± 27.6 and 36.0 ± 30.2, respectively.
The effect of LAGB was specifically analyzed in
our first 830 consecutive patients. At baseline, the
prevalence of diabetes was 11.2% (17.7% of men
and 9.2% of women, P<0.05); 36.2% of the diabetic
patients had been treated with oral hypoglycemic
drugs and the remainder with diet; none were on
Weight Loss by Laparoscopic Adjustable Gastric Banding
Obesity Surgery, 17, 2007 3
Figure 1. Case/Control Study involving 821 patients of
our Lap-Band® series and 821 patients treated by medical
therapy in other Italian Medical Centres.
Matching and Selection of Patients in the Case Group
and Control Group
4,640 Patients (BMI>40)
in 6 Italian Medical
Centers (1976-1996)
Matching for Sex (M/F)
Age (<40, 40-49, 50-59, 60-69, >70)
and BMI (40-44, 45-49, 50+)
821 patients treated by Lap-Band®
821 patients treated by medical therapy
1,015 Patients treated by
Lap-Band® Obesity
Center of Padua
(1994 al 2001)
1,388 patients treated
after 1994
821 patients
with BMI >40
Favretti 1/17/07 4:13 PM Page 3
insulin. Also preoperatively, ypercholesterolemia
was diagnosed in 53.9% of patients (48.4% in men
and 55.4% in women), low HDL-cholesterol in
13.1% (18.8% in men and 11.5% in women) and
hypertriglyceridemia in 19.4% (30.6% in men and
16.0% in women, P<0.01). The prevalence of hypertension
was 32.2% (45.9% in men and 27.9% in
women, P<0.001), with 60.6% of hypertensive
patients being treated pharmacologically.6
Postoperatively, these co-morbidities resolved or
have been markedly improved.
The results of the case/control study on the life
expectancy after LAGB are shown in Figure 8.
Kaplan-Meier survival curves were calculated at 6
months and at 1, 2, 3 and 5 years, and differences in
survival between groups was evaluated by log-rank
test. The survival rate was significantly higher in the
LAGB group (P<0.0007). Relative risk of death
after adjustment for sex, age and BMI in the surgical
group was 0.38 (95% CI: 0.17 – 0.85).7
The results of the case/control study showed
increased life expectancy after of the Lap-Band®, as
compared with medical treatment alone (Figure 8).
Discussion
True judgment of any bariatric procedure requires
sound data, not only with regard to the surgical technique
and its related mortality, morbidity and weight
loss, but also regarding the procedure’s impact on
baseline co-morbidities and life expectancy. Such
data can be provided only by studies that have a very
high follow-up rate extended over the long term.
Thus, it was our aim to provide a thorough analysis
of the Lap-Band® procedure by comprehensive longterm
data. A homogeneous series of 1,791 consecutive
patients was treated by the same team and followed
for up to 12 years. In addition, the impact of
the band on life expectancy was analyzed by a con-
Favretti et al
4 Obesity Surgery, 17, 2007
Table 2. Major complications requiring reoperation (106/1791 patients; Sept. 1993-Dec. 2005)
Complications Number Rate of Reoperation Number Rate of
Complications Complications
Stomach Slippage 70 3.9% Removal 20 1.1%
+ Pouch Dilatation Repositioning 50 2.8%
Erosion 16 0.9% Removal 16 0.9%
Psychological 14 0.7% Removal 14 0.7%
Intolerance
Miscellaneous 5 0.27% Removal 5 0.27%
(HIV, Infections,
Microperforations)
Gastric Necrosis 1 0.05% Gastrectomy 1 0.05%
Total 106 5.9% Total 106 5.9%
Unsatisfactory 41 2.3% BPD 5 0.27%
Results Removal 12 0.7%
(Lack of Compliance) “BandInaro” 24 1.3%
Table 3. Weight loss (kg, BMI, %EWL) of the entire
series
Time Weight BMI %EWL*
0 127.7±24.3 46.2±7.7 ---
1 y 103.7±21.6 37.7±7.1 40.3±19.7
2 y 101.5±23.3 36.8±7.6 43.7±21.7
3 y 102.5±22.5 37.2±7.2 41.2±23.2
4 y 104.1±23.5 37.8±7.5 38.6±24.4
5 y 105.0±23.6 38.1±7.6 37.3±25.3
6 y 105.3±24.6 38.1±8.1 37.4±28.2
7 y 106.8±24.3 38.5±7.9 35.9±26.7
8 y 105.0±24.0 37.8±7.9 37.7±26.7
9 y 103.3±26.2 37.5±8.5 38.5±27.9
10 y 101.4±27.1 37.7±9.1 35.4±29.6
11 y 101.2±31.9 38.1±11.5 38.4±32.8
12 y 84.0±27.5 31.6±8.5 49.2±49.5
Values are mean ± SD. *Based on Metropolitan tables.
Favretti 1/17/07 4:13 PM Page 4
sistent case/control epidemiological study.
The 91% follow-up rate has allowed us to provide
reliable data regarding what actually happens to this
group of patients. It is well known in bariatric circles
that not all the patients accept the stipulated follow-
up plan. We were able to track most of our
patients using an aggressive approach that sometimes
involved the Registry Offices, the Health
Authorities and even the Police.
A mortality rate of 0 in 1,791 consecutive LAGB
patients attests to the benign nature of the surgery.
In addition, this standardized laparoscopic procedure
offered patients a low rate of major complications
requiring reoperation (only 5.9 %, including
the learning curve period).
Although most of the Lap-Bands® in the series
were placed using the perigastric dissection technique
(77.8 %),3 we used the pars flaccida technique
(21.5 %)4 in the last 3 years and have utilized the
combined approach5 in only 0.8% of our cases. The
pars flaccida technique is the easiest to use and has
been found to have drastically reduced the occurrence
of certain complications.9-12 Lap-Band® surgeons
should be experienced in all three approaches
to apply whichever is necessary according to the
local anatomy and fat distribution.
Of the major complications requiring reoperation
(5.9%), stomach slippage with pouch dilatation
accounts for 3.9%. In many cases, these complications
share overlapping aspects and the same treatment:
removal of the band in 20 (1.1%) and repositioning
in 50 (2.8%) in our series. These data compare
favorably with those reported in other series,12-
15 likely due to the fact that we were able to identify
and standardize the key points of the perigastric
technique at a very early stage in our experience. Our
low erosion rate of 0.9% is similar to that reported in
other series.15,17-20 One of the most appealing aspects
of the LAGB is its total reversibility, which is important
in cases of psychological intolerance of the prosthesis.
In fact, 14 patients (0.8%) of our series
required removal of the prosthesis.
In case of unsatisfactory results, due mainly to the
patient’s lack of compliance, we offer the patient a biliopancreatic
diversion with gastric preservation (“bandinaro”).
8 This procedure was performed by laparoscopy
in 24 patients (1.3%), while the classic biliopancreatic
diversion was done in 5 (0.27%). Removal of the band
was requested by 12 patients (0.7%).
Weight Loss by Laparoscopic Adjustable Gastric Banding
Obesity Surgery, 17, 2007 5
0
20
40
60
80
100
120
140
160
180
200
0 1 y 2 y 3 y 4 y 5 y 6 y 7 y 8 y 9 y 10 y 11 y 12 y
Figure 2. Weight loss (kg) of the entire series.
0
10
20
30
40
50
60
70
0 1 y 2 y 3 y 4 y 5 y 6 y 7 y 8 y 9 y 10 y 11 y 12 y
Figure 3. Weight loss (BMI) of the entire series.
0
10
20
30
40
50
60
70
0 1 y 2 y 3 y 4 y 5 y 6 y 7 y 8 y 9 y 10 y 11 y 12 y
Figure 4. Weight loss (%EWL) of the entire series.
1791
1381 1198 1001 895 765 588 415 311 188 74 22
4
1791
1381 1198 1001 895 765 588 415 311 188 74 22
4
BMI (kg/m2) Weight (kg)
1791
1381
1198 1001 895
765 588
415 311
188
74
22
4
%EWL
Favretti 1/17/07 4:13 PM Page 5
We considered minor complications requiring reoperation
to be those occurring at the port-site (11.2%).
In most cases (10.2%), a leak was detected and the
port was replaced. In a minority of patients, the port
had to be repositioned for pain (0.5%) or removed
because of infection (0.5%). Over the length of our
series, we used all four generations of access port provided
by the manufacturer (Inamed/Allergan), and
experience indicates that with the present “low profile”
port, the leakage rate has been greatly reduced.
The preoperative weight loss (24.7 ± 11.7 kg) produced
by the BioEnterics Intragastric Balloon (BIB)
in 125/1971 super-obese patients (BMI 56.8 ± 9.1)
was associated with the same conversion rate as the
remaining series and the same rate of intra-operative
complications as well. Preoperative weight loss to
reduce the surgical risk in super-obese candidates
for bariatric surgery is an established indication for
use of the BIB.21 This sequential therapy should be
considered in patients with extreme obesity.
With regard to the weight loss curves (kg, BMI,
%EWL) (Table 3, Figures 2, 3 and 4) for the entire
series of 1791 patients, in the long term (i.e., at 10
years) the average weight had decreased 26.3 kg,
BMI was down 8.5 points and %EWL was 38.5.
The curves were stable over time, with no statisti-
Favretti et al
6 Obesity Surgery, 17, 2007
Table 4.Weight loss (kg, BMI) in morbidly obese and super-obese patients
Time Number of Patients Weight (kg) BMI (kg/m2)
MORBID SUPER MORBID SUPER MORBID SUPER
0 y 1307 484 118.4±16.9 152.8±23.7*** 42.6±4.3 56.2±5.8***
1 y 998 383 96.6±16.3 122.1±22.9*** 34.8±4.7 45.0±7.0***
2 y 862 336 95.3±20.2 117.4±23.4*** 34.3±6.2 43.3±7.3***
3 y 710 291 96.4±18.1 118.0±24.8*** 34.7±5.2 43.5±7.7***
4 y 642 253 97.7±18.7 120.3±26.6*** 35.2±5.4 44.3±8.1***
5 y 546 219 98.6±18.9 121.3±26.6*** 35.6±5.5 44.6±8.4***
6 y 417 171 98.6±19.4 122.3±28.0*** 35.4±5.8 44.9±9.1***
7 y 290 125 100.5±19.8 121.8±27.4*** 35.8±5.7 44.8±8.7***
8 y 227 84 99.0±19.1 122.0±28.1*** 35.4±5.6 44.5±9.4***
9 y 140 48 96.7±18.2 123.6±35.2*** 35.0±5.4 44.9±13.9***
10 y 56 18 94.6±18.0 123.2±38.5** 35.2±5.4 45.7±13.5***
11 y 17 5 92.1±20.3 137.7±48.9* 34.4±6.6 53.0±16.2**
12 y 4 0 84.0±27.5 – 31.6±8.5 –
Student’s t-test: *P<0.05; **P<0.01; ***P<0.001. Values are mean ± SD.
0
20
40
60
80
100
120
140
160
180
0y 1y 2y 3y 4y 5y 6y 7y 8y 9y 10y 11y 12y
Super Morbid
Figure 5. Weight loss (kg) in super and morbid obese
patients.
0
10
20
30
40
50
60
70
0y 1y 2y 3y 4y 5y 6y 7y 8y 9y 10y 11y 12y
Super Morbid
Figure 6. Weight loss (BMI) in super and morbid obese
patients.
484
383
336 291 253 219 171 125 84 48 18
5
1307
998 862 710 642 546 417 290 227 140 56 17
4
Weight (kg)
484
383
336 291 253 219 171 125 84 48 18
5
1307
998 862 710 642 546 417 290 227 140 56 17
4
BMI (kg/m2)
Favretti 1/17/07 4:13 PM Page 6
cally detectable rebound. Stable curves in the long
term were visible in the weight loss curves (kg,
BMI) of the morbidly obese and super-obese groups
(Table 4, Figures 5 and 6) where we observed a
weight loss of 23.8 and 29.6 kg, respectively at 10
years. The BMI was down 7.4 and 11.3 points in the
same time-span, respectively.
%EWL in the morbidly obese and in the superobese
(Table 5 and Figure 7) was 40.3 and 36.0,
respectively at 10 years. After the 4th year, there
was no statistical difference between the value of
the two curves and they tended to merge together.
The weight loss observed in morbidly obese
patients in the first 12 to 18 months after LAGB was
associated with clinically-significant improvements
in multiple cardiovascular risk factors. However,
only a low level of correlation was observed between
the degree of body weight reduction and the magnitude
of cardiovascular risk improvement. In particular,
a 10% to 11% weight loss appeared to be associated
with the maximal benefit in diabetic control,
with no further gain being derived from more pronounced
levels of body weight reduction.6,23
Weight Loss by Laparoscopic Adjustable Gastric Banding
Obesity Surgery, 17, 2007 7
Table 5.Weight loss (%EWL) in morbidly obese and super-obese patients
Time Number of Patients Weight Loss %EWL*
MORBID SUPER MORBID SUPER MORBID SUPER
0 y 1307 484 --- --- --- ---
1 y 998 383 21.7±11.2 30.9±15.6*** 42.3±20.4 35.1±16.6***
2 y 862 336 23.2±15.5 34.4±16.9*** 45.2±25.5 39.8±18.5**
3 y 710 291 21.8±13.4 33.7±18.0*** 42.1±20.4 39.1±19.5*
4 y 642 253 20.5±13.5 31.0±19.2*** 39.6±25.5 36.2±21.0*
5 y 546 219 19.8±13.8 30.1±19.6*** 38.1±26.5 35.1±21.7
6 y 417 171 20.1±15.1 29.1±21.5*** 38.7±29.7 33.9±23.9*
7 y 290 125 18.7±13.5 29.0±20.4*** 36.6±27.8 34.0±23.9
8 y 227 84 19.9±13.9 28.7±20.5** 38.8±27.2 34.5±24.9
9 y 140 48 20.2±13.9 26.1±22.4 40.3±27.6 32.9±28.7
10 y 56 18 17.6±14.2 29.2±22.7 35.2±29.7 36.0±30.2
11 y 17 5 20.5±18.6 25.7±5.1 40.9±36.1 28.3±13.3
12 y 4 0 16.5±14.6 – 49.2±49.5 –
Student’s t-test: *P<0.05; **P<0.01; ***P<0.001. Values are mean ± SD. *based on the Metropolitan Tables.22
0
10
20
30
40
50
60
0y 1y 2y 3y 4y 5y 6y 7y 8y 9y 10y 11y 12y
Super Morbid
Figure 7. Weight loss (%EWL) in super and morbid
obese patients.
90
92.5
95
97.5
100
0.5 1 2 3 4 5
years
Survival
Figure 8. Life Expectancy in a Case/Control Study involving
821 patients of our Lap-Band® Series and 821
patients treated by medical therapy in other Italian
Medical Centers.
484
383
336 291
253 219 171 125 84
48
18
5
LAGB non-LAGB
1307
998
862
710
642 546 417
290 227
140
56
17
4
%EWL
% Survival
Favretti 1/17/07 4:13 PM Page 7
Life Expectancy Study
Working together with Epidemiolgists and
Internists of the Multisites Cohort of the Italian
Study Group on Morbid Obesity, our group was
able to conduct a case/control study on the effect of
LAGB on life expectancy.
Of our patients, 821/1791were matched with 821
similar patients who received only medical treatment
(Figure 1). The 5-year survival in the LAGB-treated
group and in the medically-treated group is shown in
Figure 8, where a statistically significant difference in
survival is seen in favor of the surgically-treated
group, with a 60% reduction in total mortality.7
It has been uncommon to find reports of long-term
results with gastric banding. The fact that the band
was only introduced in 1993 would explain the lack
of long-term data. It is even less common to find studies
that provide the impact of a single bariatric operation
on the life expectancy of the patients. Thus, the
data presented here will enable comparison of the different
operations as bariatric surgery advances.
Conclusions
This study affirms that the LAGB is safe and effective
for the treatment of both morbidly obese and superobese
patients in the short, medium and long term. In
experienced hands, the complication rate is low and
stable weight loss to at least 12 years has occurred.
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(Received September 5, 2006; accepted December 16, 2006)
Favretti et al
8 Obesity Surgery, 17, 2007
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