Surgical Endoscopy

, Volume 23, Issue 7, pp 1569–1573 | Cite as

Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2

  • Samuel Sultan
  • Manish Parikh
  • Heekoung Youn
  • Marina Kurian
  • George Fielding
  • Christine Ren



Many mildly to moderately obese individuals with a body mass index (BMI) lower than 35 kg/m2 have serious diseases related to their obesity. Nonsurgical therapy is ineffective in the long term, yet surgery has never been made widely available to this population.


Between 2002 and 2007, 53 patients with a BMI lower than 35 kg/m2 underwent laparoscopic adjustable gastric banding at our institution. Data on all these patients were collected prospectively and entered into an institutional review board–approved electronic registry. The study parameters included preoperative age, gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities.


The mean preoperative age of the patients was 46.9 years (range, 16–68 years), and the mean preoperative BMI was 33.1 kg/m2 (range, 28.2–35.0 kg/m2). Of the 53 patients, 49 (92%) had at least one obesity-related comorbidity. The mean BMI decreased to 28.1 ± 2.4 kg/m2, 25.8 ± 2.9 kg/m2, and 25.8 ± 3.1 kg/m2 and mean %EWL was 48.3 ± 17.6, 69.9 ± 28.0, and 69.7 ± 31.7 at 0.5, 1, and 2 years, respectively. Substantial improvement occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive sleep apnea, hypercholesterolemia, and osteoarthritis. There was one slip, two cases of band obstruction (from food), two cases of esophagitis, and two port leaks, but no mortality.


The authors are very encouraged by this series of low-BMI patients who underwent laparoscopic adjustable gastric banding. Their weight loss has been excellent, and their complications have been acceptable. Their comorbidities have partially or wholly resolved. With further study, it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m2.


BMI less than 35 Lap band Low BMI Mild to moderate obesity 


  1. 1.
    Ogden CL, Carroll MD, McDowell MA, Flegal KM (2007) Obesity among adults in the United States—no statistically significant change since 2003–2004. NCHS data brief number 1, National Center for Health Statistics, Hyattsville, MDGoogle Scholar
  2. 2.
    WHO Consultation on Obesity (1999) Obesity: preventing and managing the global epidemic: report of a WHO consultation, WHO, Geneva, SwitzerlandGoogle Scholar
  3. 3.
    Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes Lond 29:1153–1167PubMedCrossRefGoogle Scholar
  4. 4.
    Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H, Swedish Obese Subjects Study Scientific Group (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693PubMedCrossRefGoogle Scholar
  5. 5.
    Consensus Development Conference Panel (1991) Gastrointestinal surgery for severe obesity. Ann Intern Med 115:956–961Google Scholar
  6. 6.
    Angrisani L, Favretti F, Furbetta F, Iuppa A, Doldi SB, Paganelli M, Basso N, Lucchese M, Zappa M, Lesti G, Capizzi FD, Giardiello C, Di Lorenzo N, Paganini A, Di Cosmo L, Veneziani A, Lacitignola S, Silecchia G, Alkilani M, Forestieri P, Puglisi F, Gardinazzi A, Toppino M, Campanile F, Marzano B, Bernante P, Perrotta G, Borrelli V, Lorenzo M (2004) Italian group for lap-band system: results of multicenter study on patients with BMI ≤ 35 kg/m2. Obes Surg 14:415–418PubMedCrossRefGoogle Scholar
  7. 7.
    O’Brien PE, Dixon JB, Laurie C, Skinner S, Proietto J, McNeil J, Strauss B, Marks S, Schachter L, Chapman L, Anderson M (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144:625–633PubMedGoogle Scholar
  8. 8.
    Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 299:316–323PubMedCrossRefGoogle Scholar
  9. 9.
    Ren CJ, Fielding GA (2003) Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A 13:257–263PubMedCrossRefGoogle Scholar
  10. 10.
    Gulkarov I, Wetterau M, Ren CJ, Fielding GA (2007) Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation. Surg Endosc 22:1035–1041Google Scholar
  11. 11.
    Shen R, Dugay G, Rajaram K, Cabrera I, Siegel N, Ren CJ (2004) Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg 14:514–519PubMedCrossRefGoogle Scholar
  12. 12.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRefGoogle Scholar
  13. 13.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the united states, 1999–2004. JAMA 295:1549–1555PubMedCrossRefGoogle Scholar
  14. 14.
    Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr (1999) Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341:1097–1105PubMedCrossRefGoogle Scholar
  15. 15.
    Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N (2002) Gastric bypass in patients with BMI 32 without life-threatening comorbidities: preliminary report. Obes Surg 12:52–56PubMedCrossRefGoogle Scholar
  16. 16.
    Parikh M, Duncombe J, Fielding GA (2006) Laparoscopic adjustable gastric banding for patients with body mass index of ≤35 kg/m2. Surg Obes Relat Dis 2:518–522PubMedCrossRefGoogle Scholar
  17. 17.
    Parikh M, Lo H, Chang C, Collings D, Fielding G, Ren C (2006) Comparison of outcomes after laparoscopic adjustable gastric banding in African Americans and whites. Surg Obes Relat Dis 2:607–610, discussion 610–612Google Scholar
  18. 18.
    Parikh M, Ayoung-Chee P, Romanos E, Lewis N, Pachter HL, Fielding G, Ren C (2007) Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass, and biliopancreatic diversion. J Am Coll Surg 205:631–635PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Samuel Sultan
    • 1
  • Manish Parikh
    • 1
  • Heekoung Youn
    • 1
  • Marina Kurian
    • 1
  • George Fielding
    • 1
  • Christine Ren
    • 1
  1. 1.NYU School of MedicineNew YorkUSA

Personalised recommendations