The findings of a new study published in Annals of Surgery demonstrate that laparoscopic adjustable gastric banding (Lap-Band) is both a safe and effective long-term strategy for managing obesity. The study followed patients for 15 years after surgery, making it the longest and most comprehensive Lap Band follow-up study yet reported. Researchers from Monash University examined the results of gastric banding in more than 3200 patients who underwent the procedure between 1994, (when the procedure was first introduced) and 2011. The authors also did a sub analysis of their data for 3 distinct time periods in the evolution of the Lap-Band device and techniques for implantation:
1. Perigastric era (1994-2000) where the surgeon dissected very close to the stomach in order to place the band.
2. Pars flaccida era (2001-2005) where the surgeon dissected along the diaphragm, behind the junction of the esophagus and stomach for band placement.
3. Lap-Band AP (2006-2011) where the new “advanced platform” band was placed, which has preformed creases, holds more volume and is lower pressure than the prior Lap-Bands.
A total of 714 of the patients had surgery 10 or more years ago and maintained an average weight loss of about 57 pounds, or nearly half of their excess weight. They saw similar results in the 54 patients who had received gastric banding at least 15 years ago. All of the patients in the study received treatment from Professor Paul O’Brien, who is an international leader in laparoscopic adjustable gastric banding, and Associate Professor Wendy Brown, President of the Obesity Surgery Society of Australia and New Zealand (OSSANZ).
In terms of safety, there were no deaths associated with the surgery or with any further operations that were later needed in about half of the patients. 5.6% of patients had their band removed during the study period, and this decreased from 9.9% in the first, perigastric era, to just 2.2% in the current, Lap-Band AP era. Similarly, revisional surgery for band slippage or pouch enlargement decreased from 40% to under 7% between the first and third eras. The study authors also note that patients who had revisional surgery lost as much weight in the long-term as those who didn’t require a revision.
In the same paper the authors also included their results of a systematic review of publications of all bariatric procedures with 10 years or more follow-up. They found that all current procedures are associated with greater than 50% excess weight loss on average. The weighted mean at maximum followup for gastric banding was 54.2 % and for gastric bypass it was 54%.
We spoke with Dr George Fielding, a pioneer in Lap Band surgery. He said, “This is the largest long term follow up study on the lap band, by the surgeon from Australia who has done more than anyone to explain the band’s benefits over the last 15 years.” Dr. Fielding has a particularly personal understanding of the benefits of the Lap Band; he underwent Lap Band surgery years ago. “Dr O’Brien did my band 13 years ago, and my weight is stable. I’ve lost 110lbs. The most important part of this study is the demonstration of reduction in need for reoperation over the last few years, due to the change to Pars flaccida technique, the use of bigger, softer bands, and awareness of the need to repair hiatal hernias. O’Brien’s results show that the band can be used, very safely, over a long time.”
Dr. David Voellinger, an expert weight loss surgeon in North Carolina, also spoke with us about the study’s implications. He said, “With the recent controversies surrounding the Lap-Band, this is a very timely review. Dr. O’Brien and his team have comprehensively and positively addressed long-term weight loss with the band and re-operation rate after the band. His sub-analysis by timeline is particularly important as it shows the improvements made over time in both the device and in surgical technique. It also very clearly shows the importance of a dedicated, multi-disciplinary program with understanding of band physiology to obtain lasting success with the Lap-Band.”
Dr. O’Brien concluded that his findings show that “laparoscopic adjustable gastric banding is safe and effective, and has lasting benefits. Significant weight loss can improve the lives of people who are obese and they can be healthier and live longer.” Finally, he noted that weight loss induced by Lap-Band surgery can effectively control diabetes symptoms without the need for medication in about three-quarters of cases. You can read more about how effective weight loss surgery is at resolving type 2 diabetes in obese patients here.
by Emma Squillace
Weight Loss Studies & Clinical