LAP-BAND-weight loss procedure safe and effective for obese people

Published on May 2, 2013 at 10:24 AM · 1 Comment

The LAP-BAND- weight loss procedure is safe and effective in an expanded group of patients, not just in people who are morbidly obese. This conclusion is reported in a new study published in the scientific journal Obesity. The findings indicate that the procedure may help to intervene before obesity becomes life threatening to patients.

In 2001 the LAP-BAND- adjustable gastric banding system (LAGB) was approved by the FDA as weight loss procedure for patients with a body mass index (BMI) of 40 kg/m2 or higher and for patients with a BMI of at least 35 with an obesity-related condition, such as diabetes or hypertension. (A person with a BMI of 30 or higher is considered obese.) During the procedure, a surgeon makes small incisions in the patient's abdomen and places an adjustable band around the upper part of the stomach. The newly created upper pouch allows the patient to eat only small amounts of food at a time, and it provides prolonged appetite suppression.

To assess the safety and effectiveness of LAGB in an expanded group of patients, Robert Michaelson, MD, PhD, FACS, of Northwest Weight Loss Surgery in Everett, Washington, and his colleagues recruited 149 individuals with a BMI of 35 to 39.9 without an additional condition, or a BMI of 30 to 34.9 with at least one obesity-related condition.

"Patients in our study had been obese for an average of 17 years," said Dr. Michaelson. "They tried numerous other weight loss methods and finally reached out for surgical treatment when they were weary of the repetitive failures at maintaining weight loss."

One year after undergoing the procedure, 84.6% of patients achieved at least a 30 percent loss in excess body weight, with an average excess weight loss of 65 percent. A total of 66.4 percent of patients were no longer obese. Obesity-related conditions that were present at the time of surgery improved for many patients, including 64.4 percent of patients who had high cholesterol, 59.6 percent of patients who had hypertension, and 85.7 percent of patients who had diabetes. Patients' quality of life also improved. Most side effects were mild to moderate and resolved within one month.

The researchers also found that the one year results were maintained or improved at two years, and that each additional 10 percent weight loss at year two was linked with a decrease in triglycerides by 13.7mg/dL, blood sugar levels by 3.5mg/dL, and systolic blood pressure by 3.3mmHg.

"The results of this study convinced the FDA that early intervention in the continuum of obesity is the right thing to do: treat before people go on to develop serious comorbid conditions of obesity," said Dr. Michaelson. He added that this and similar studies prompted the American Society for Metabolic and Bariatric Surgery to issue a position statement endorsing weight loss surgery for patients with moderate obesity who have failed non- surgical methods of weight loss. "The next step is to get the private insurers and Medicare, who continue to rely on guidelines established in 1991, to review the incontrovertible literature, take down the barriers to the necessary treatment for this disease, and offer the hope of a cure to 27 million Americans," said Dr. Michaelson.

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  1. Darliene Howell Darliene Howell United States says:

    Facts about Gastric Banding:

    A Finnish study found that “The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years.” [P. Tolonen, M. Victorzon, J. Makela, 11-year experience with laparoscopic adjustable gastric banding for morbid obesity--what happened to the first 123 patients?, Obesity Surgery, 2008]

    A study published this year in Archives of Surgery reassessed about 80 people who had gastric bands inserted between 1994 and 1997. They reported that “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%), [banding] appears to result in relatively poor long-term outcomes.” [J. Himpens, et al, Long-term Outcomes of Laparoscopic Adjustable Gastric Banding, Archives of Surgery, 2011]

    Dr. David Urbach of Toronto Western Hospital told CTV News he has treated patients who were “left in severe pain when their bands caused their stomachs to twist.” In other cases, the band’s plastic material had eroded into the stomach. In others, they slip because of vomiting or overeating, so the pouch size and shape changes, causing problems. [Study cites high Lap-Band complication, removal rates, edmonton.ctv.ca/.../lap-band-surgery-110329]

    In the article, Limitations of Adjustable Gastric Banding Obesity Treatment [Eating Disorders by suite101], it is brought out that:
    • A Dutch research study of 201 patients who had the procedure between 1995 -2003 concluded that adjustable gastric banding not only results in modest weight loss, but the benefit of the procedure deteriorates over time. [Aarts E et al. Disappointing results in the long run after gastric banding, ASMBS 2010; Abstract PL-118.]
    • Eating Disorders Review highlights that 80% of adjustable gastric banding patients retained weight loss during the first three years then decreased to 64% at five years and just 20% at ten years following surgery. In addition, significant deterioration of diabetes control and hypertension became evident over time. [UPDATE: Benefits of Adjustable Gastric Banding May Fade with Time, Eating Disorders Review, Sept/Oct 2010 Vol 21, Number 5]

    The study referenced concluded that 5 years after surgery, about 75% of patients maintained a 25% excess weight loss. At 10 years, the success rate dropped to less than 33%. Using excess weight loss of 25% or more to define treatment success, the Dutch surgeons found that about 80% of the patients retained weight loss during the first 3 years; after this there was a steady decline to 64% of patients at 5 years, and 20% at 10 years. Control of diabetes, hypertension, and gastro esophageal reflux all deteriorated significantly over time. The incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.

    The results of Reasons and outcomes of laparoscopic revisional surgery after laparoscopic gastric banding for morbid obesity, a 2011 study of procedures performed from February 2001 to October 2008, showed:
    • Of 343 patients who had undergone primary LAGB, 60 subsequently underwent a revisional procedure, including 39 (44.3%) band removals
    The study concludes that:
    “Although reversible and efficacious, LAGB [laparoscopic adjustable gastric banding] appears to have a high incidence of complications requiring revisional surgery and/or band removal.” [S. Patel, et al, Reasons and outcomes of laparoscopic revisional surgery after laparoscopic gastric banding for morbid obesity, Surgery for obesity and related diseases, 2011]

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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