High Complications from Weight Loss Surgery, Study Claims

complications weight loss surgeryA recent study from Belgium – the Himpens study- claims that gastric bands have quite a high complication and erosion rate. While at first glance these results sound concerning, we turned to several of the US’s most experienced gastric band surgeons for their opinions.

To start, we asked Dr. Christine Ren-Fielding what the average person should look at when they’re trying to understand a study like this. She says “one of the most important thing to look at when evaluating a study is to make sure it applies to the present day standard of care. For example, it makes no sense studying the risks and benefits of radical mastectomy for breast cancer, when that surgical technique is no longer used, but rather a modified radical mastectomy or even a lumpectomy with axillary node dissection.

In the case of this study, the gastric banding surgical technique has evolved so much since 1996 (when the patients in this study had their band surgery) that these results are not generalizable to patients undergoing gastric banding in this decade. In addition, it was because of those known complications of bands, that surgical technique and device design have changed and improved over the past 15 years. In fact, in 1998, Dr. George Fielding revolutionized the surgical technique of how bands are placed, due to the high band slippage rate that was occuring. The original ‘peri-gastric’ technique was then replaced by the ‘pars flaccida’ technique and proved to decrease the band slip rate from 20 percent to 5 percent.”

Further, patients should not assume that all gastric band surgeons are equal. Surgeon selection is one of the most important decisions a potential bariatric surgery patient will make. Dr. Ren-Fielding says “It is important to go to an experienced surgeon because those individuals tend to have lower complication rates. This study showed an almost 30 percent band erosion rate, which has never been seen before in any surgical practice nor in any medical study. This incredibly high complication rate is staggering. Simply, it is hard to comprehend that it is device related, but rather surgeon related. It is most likely due to the fact that these surgeons performed 151 band operations over 4 years, which averages out to 37 per year at their institution.” We don’t know how many bands each individual surgeon performed, but these very low procedure numbers would explain their apparent inexperience and subsequent high complication rate.

Another aspect to consider from this study is the follow up. Dr. Emma Patterson, CEO of Oregon Weight Loss Surgery, says “Follow up is very important in any weight loss program, and especially with Bands as they are adjustable. We can only adjust them if the patient comes in. Follow up visits are also important times when eating and exercise habits are reviewed and the patient gets education. Without this, they can develop maladaptive eating patterns.” Dr. Patterson says that experienced US bariatric surgeons generally see patients more than twice as many times as the patients were seen in the Himpens study. “This study was also poorly designed, as it is a single-center, retrospective study. Interestingly though, the patients who kept their bands had good weight loss and quality of life and were very satisfied with the procedure overall,” Patterson notes.

How do US bariatric surgeons view complication rates? Dr. Ren-Fielding says “This is the reason that in the US we have benchmarking in the medical field. Certain complication rates are acceptable, however we should all strive towards the benchmark, which is established by many organizations including the University Healthcare Consortium. For bariatric surgery, UHC has an extremely low complication rate for bands. In our series of 2909 band patients out to 6 years, we have seen a 0.2% percent erosion rate and 12 percent complication rate, which is significantly lower than what is seen in the Himpens paper.” In 2009, the researchers in the Himpens study were able to follow up with only 82 of 151 patients, compared to almost 3,000 patients in Dr. Ren-Fielding’s study.

The best physicians are constantly looking for ways to improve what they do, questioning results, and striving for better. And while studies like the Himpens paper are cause to stop and really look into what’s being said, the key is to judge the data appropriately, before making your own decision about what is and isn’t an accurate depiction of the gastric band procedure. Most importantly, talk to a highly experienced bariatric surgeon about any concerns or questions you have.

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