Skip to main content
SpringerLink
Log in

Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes.

Methods

A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%).

Results

After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5–7 years at approximately 15 kg/m2 for the LRYGB patients and at about 9 kg/m2 for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group.

Conclusions

Over the long term, LRYGB had an approximate reduction of 15 kg/m2 BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241

    Article  PubMed  CAS  Google Scholar 

  2. Brown WV, Fujioka K, Wilson PW, Woodworth KA (2009) Obesity: Why be concerned? Am J Med 122(4 Suppl 1):S4–S11

    PubMed  Google Scholar 

  3. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J (2007) Medicare's search for effective obesity treatment: diets are not the answer. Am Psychol 62(3):220–233

    Article  PubMed  Google Scholar 

  4. Nguyen NT, Slone JA, Nguyen XM, Hartman JS, Hoyt DB (2009) A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and cost. Ann Surg 250:631–641

    PubMed  Google Scholar 

  5. Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  6. DeMaria EJ, Sugerman HJ, Meador JG et al (2001) High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 233:809–818

    Article  PubMed  CAS  Google Scholar 

  7. Weber M, Muller MK, Bucher T et al (2004) Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg 240:975–982

    Article  PubMed  Google Scholar 

  8. O’Brien PE, McPhail T, Chaston TB, Dixon JB (2006) Systematic review of medium-term weight loss after bariatric operations. Obes Surg 16:1032–1040

    Article  PubMed  Google Scholar 

  9. O’Brien PE (2009) Is weight loss more successful after gastric bypass than gastric banding for obese patients? Nat Clin Pract Gastroenterol Hepatol 6:136–137

    Article  PubMed  Google Scholar 

  10. Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12:564–568

    Article  PubMed  CAS  Google Scholar 

  11. US Food and Drug Administration (FDA) (2011) FDA news release. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm245617.htm. Accessed 10 July 2011

  12. Spivak H, Hewitt MF, Onn A, Half EE (2005) Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg 189:27–32

    Article  PubMed  Google Scholar 

  13. Consensus Development Conference Panel (1991) NIH conference: gastrointestinal surgery for severe obesity. Ann Intern Med 115:956–961

    Google Scholar 

  14. Rubin M, Benchetrit S, Lustigman H, Lelcuk S, Spivak H (2001) Laparoscopic gastric banding with Lap-Band for morbid obesity: two-step technique may improve outcome. Obes Surg 11:315–317

    Article  PubMed  CAS  Google Scholar 

  15. Spivak H, Favretti F (2002) Avoiding postoperative complications with the Lap-Band system. Am J Surg 184:31S–37S

    Article  PubMed  Google Scholar 

  16. Spivak H, Beltran OR, Slavchev P, Wilson EB (2007) Laparoscopic revision from Lap-Band to gastric bypass. Surg Endosc 21:1388–1392

    Article  PubMed  Google Scholar 

  17. Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357

    Article  PubMed  Google Scholar 

  18. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232(4):515–529

    Article  PubMed  CAS  Google Scholar 

  19. Clavien PA, Barkum J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  20. Angrisani L, Lorenzo M, Borrelli V (2007) Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis 3:127–132

    Article  PubMed  Google Scholar 

  21. Boza C, Gamboa C, Awruch D et al (2010) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding: five years of follow-up. Surg Obes Relat Dis 6:470–475

    Article  PubMed  Google Scholar 

  22. Christou N, Efthimiou E (2009) Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada. Can J Surg 52:E249–E258

    PubMed  Google Scholar 

  23. Favretti F, Segato G, Ashton D et al (2007) Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg 17:168–175

    Article  PubMed  Google Scholar 

  24. Tolonen P, Victorzon M, Mäkelä J (2008) 11-Year experience with laparoscopic adjustable gastric banding for morbid obesity: What happened to the first 123 patients? Obes Surg 18:251–255

    Article  PubMed  Google Scholar 

  25. Suter M, Calmes JM, Paroz A, Giusti V (2006) A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg 16:829–835

    Article  PubMed  CAS  Google Scholar 

  26. Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I (2003) Outcome after laparoscopic adjustable gastric banding: 8 years experience. Obes Surg 13:427–434

    Article  PubMed  CAS  Google Scholar 

  27. Himpens J, Cadiere GB, Bazi M, et al. (2011) Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg 146(7):802–807

    Article  PubMed  Google Scholar 

  28. Pories W, Swanson M, MacDonald K (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350

    Article  PubMed  CAS  Google Scholar 

  29. Jones K (2000) Experience with the Roux-en-Y gastric bypass and commentary on current trends. Obes Surg 10:183–185

    Article  PubMed  Google Scholar 

  30. Sugerman HJ, Wolfe LG, Sica DA, Clore JN (2003) Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 237:751–756

    PubMed  Google Scholar 

  31. Christou NV, Look D, Maclean LD (2006) Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244:734–740

    Article  PubMed  Google Scholar 

  32. Higa K, Ho T, Tercero F, Yunus T, Boone KB (2010) Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis 6:249–253

    Article  Google Scholar 

  33. DiGiorgi M, Rosen DJ, Choi JJ et al (2010) Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis 6:249–253

    Article  PubMed  Google Scholar 

  34. Spivak H, Gold D, Guerrero C (2003) Optimization of access-port placement for the Lap-band system. Obes Surg 13:909–912

    Article  PubMed  Google Scholar 

  35. Zieren J, Menenakos C, Paul M, Müller JM (2004) Prevention of catheter disconnection after laparoscopic adjustable gastric banding. J Laparoendosc Adv Surg Tech A 14:77–79

    Article  PubMed  Google Scholar 

  36. Jan JC, Hong D, Bardaro SJ et al (2007) Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery. Surg Obes Relat Dis 3:42–50

    Article  PubMed  Google Scholar 

Download references

Disclosures

Hadar Spivak was involved in the proctorship program of Ethicon Endo Surgery and Inamed corporations during the years 2002–2005. He also served on the advisory board for Bioenterics in 2001 and 2002. Hadar Spivak, Mena F. Abdelmelek, Oscar R. Beltran, Amelia W. Ng, and Seiichi Kitahama have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. HS Laparoscopy, Weight-Loss Surgery Program, Park Plaza Hospital, 1313 Hermann Drive, 1200 Binz Suite 930, Houston, TX, 77004, USA

    Hadar Spivak, Mena F. Abdelmelek, Oscar R. Beltran, Amelia W. Ng & Seiichi Kitahama

Authors
  1. Hadar Spivak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mena F. Abdelmelek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oscar R. Beltran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amelia W. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seiichi Kitahama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hadar Spivak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spivak, H., Abdelmelek, M.F., Beltran, O.R. et al. Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surg Endosc 26, 1909–1919 (2012). https://doi.org/10.1007/s00464-011-2125-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-2125-z

Keywords

Search

Navigation