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Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents—a National Registry-Based Study

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Abstract

Objective

Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents.

Methods

A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases.

Results

Two hundred fifty-nine adolescents (60% females) aged 12–19 years were included. Mean age and body mass index (BMI) were 17.5 ± 1.2 years and 45.1 ± 5.0 kg/m2, respectively. LSG (n = 227, 87.6%) and LAGB (n = 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 ± 4.7 kg/m2 vs. 10.3 ± 5.1 kg/m2 respectively; p = 0.0001) and higher rate with BMI < 30 kg/m2 1 year post-surgery (57.7% (n = 131) vs. 25% (n = 8), respectively; p = 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7–9.9) followed by age (OR = 1.3; 95% CI1.0–1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7–7.9; p = 0.1).

Conclusion

Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.

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Abbreviations

LABG:

Laparoscopic adjustable gastric banding

BMI:

Body mass index

SAGB:

Single anastomosis gastric bypass

HMO:

Health maintenance organizations

LRYGB:

Laparoscopic Roux-en-Y gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

HEMR:

Hospital electronic medical records

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Acknowledgments

We want to thank Mrs. Carmel Sherf for assistance in collecting the data. The authors thank the bariatric surgery department’s staff from all medical centers in Israel for their cooperation.

Funding

The study did not receive any grant support. This study was conducted as part of the responsibilities of the Israel MOH to collect data on adolescents undergoing bariatric surgery. The funding was available as part of the annual budget of the Israel Center for Disease Control.

Author information

Authors and Affiliations

  1. Israel Center for Disease Control, Ministry of Health, Chaim Sheba Medical Center, 52621, Ramat Gan, Israel

    Orit Blumenfeld, Rita Dichtiar & Lital Keinan-Boker

  2. Department of Surgery, Hadassah Har Hazofim Medical Center, Jerusalem, Israel

    Nahum Beglaibter

  3. Department of Surgery, Poria Medical Center, Tiberius, Israel

    Nissim Geron

  4. Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel

    David Hazzan & David Goitein

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Hazzan & David Goitein

  6. School of Public Health, University of Haifa, Haifa, Israel

    Lital Keinan-Boker

Authors
  1. Orit Blumenfeld
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  2. Nahum Beglaibter
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  3. Nissim Geron
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  4. Rita Dichtiar
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  5. David Hazzan
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  6. Lital Keinan-Boker
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  7. David Goitein
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Contributions

O.B initiated the study, collected the data, had complete access to the study data, interpreted the data, and wrote the manuscript. B.N revised the final version of the manuscript, D.R had complete access to the study data and performed the statistical analysis. H.D and KBL revised the final version of the manuscript and G.D assisted in interpretation of data and in drafting the paper.

Corresponding author

Correspondence to Orit Blumenfeld.

Ethics declarations

Ethics Approval and Consent to Participate

This study was approved by the ethical review board at the Sheba Medical Center (the ICDC resides in this campus) (approval # 3857-17-SMC). This study was conducted as part of the responsibilities of the Israel Ministry of Health to collect data on adolescences who underwent bariatric surgery. This research was based on these data. The Ministry of Health is able to collect data by virtue of the provision of section 29A and the Public Health ordinance 1940.

https://www.health.gov.il/LegislationLibrary/Sherutei03.pdf

Consent for Publication

The ethical review board waived the need for consent.

Competing Interest

The authors declare that they have no competing interests.

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Appendix

Appendix

Table 3 Characteristics of patients by type of surgical procedure at baseline
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Blumenfeld, O., Beglaibter, N., Geron, N. et al. Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents—a National Registry-Based Study. OBES SURG 30, 296–303 (2020). https://doi.org/10.1007/s11695-019-04155-1

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  • DOI: https://doi.org/10.1007/s11695-019-04155-1

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