Efficacy of a low-pressure laparoscopic adjustable gastric band for morbid obesity: patients at long term in a multidisciplinary center

Abstract

Background: Obesity is an increasingly common condition with serious associated morbidity and decreased life expectancy. Laparoscopic adjustable gastric banding (LAGB) has demonstrated its safety and efficacy as a surgical therapy for morbid obesity over the short term. The current study sought to determine the long-term safety and efficacy of a low-pressure LAGB.

Methods: Between August 1996 and July 2007, 1,000 consecutive patients underwent LAGB implantation with the Swedish Adjustable Gastric Band (SAGB). This series was retrospectively reviewed with regard to weight loss and morbidity. Patients served as their own controls.

Results: Preoperatively, there were 808 women (81.0%) and 192 men (19.0%) with a mean age of 46 +/- 11 years (range 13-81 yrs) and mean body mass index (BMI) of 42.0 +/- 7.0 kg/m2 (range 27-82 kg/m2). At 1-, 3-, 6-, and 8-year follow-up, mean percent excess weight loss was 41% (n = 600), 56% (n = 367), 51% (n = 114), and 52% (n = 43), respectively. At the same time points, BMI decreased, from 42.0 to 31.0, 32.5, and 30.5 kg/m2, respectively. Complications occurred in 197 patients. There were 2 operative complications (i.e., stomach perforation and vascular injury) and 25 conversions (2.4%) to open surgery. Major and minor wound infection in the perioperative period occurred in 47 (4.7%) and 43 (4.3%) patients, respectively. There was 1 death from a myocardial infarct 1 week after surgery. Long term, there were 30 (3.0%) band slippages, 31 (3.1%) erosions, 67 (6.7%) port problems, and 12 (1.2%) incisional hernias.

Conclusion: LAGB with the SAGB is effective in achieving a mean sustainable weight loss of >50% at 8 years after surgery, with an acceptably low morbidity.