Obesity Surgery

, Volume 17, Issue 2, pp 168–175 | Cite as

Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results

  • Franco Favretti
  • Gianni Segato
  • David Ashton
  • Luca Busetto
  • Maurizio De Luca
  • Marco Mazza
  • Andrea Ceoloni
  • Oscar Banzato
  • Elisa Calo
  • Giuliano Enzi
Article

Background

This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common.

Methods

Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 ± 24 kg, mean BMI 46.2 ± 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, shortand long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy.

Results

Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5).Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7%), and other 1 (0.05%). Port-related complications occurred in 200 patietns (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation (“bandinaro”) in 24 (1.3%). Weight in kg was 103.7 ± 21.6, 102.5 ± 22.5, 105.0 ± 23.6, 106.8 ± 24.3, 103.3 ± 26.2 and 101.4 ± 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 ± 7.1, 37.2 ± 7.2, 38.1 ± 7.6, 38.5 ± 7.9, 37.5 ± 8.5 and 37.7 ± 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group.

Conclusions

LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount.

Key words

Morbid obesity laparoscopy adjustable gastric banding intragastric balloon bariatric surgery longterm outcome 

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Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Franco Favretti
    • 1
    • 4
  • Gianni Segato
    • 1
  • David Ashton
    • 2
  • Luca Busetto
    • 3
  • Maurizio De Luca
    • 1
  • Marco Mazza
    • 3
  • Andrea Ceoloni
    • 1
  • Oscar Banzato
    • 1
  • Elisa Calo
    • 3
  • Giuliano Enzi
    • 3
  1. 1.Department of SurgeryRegional HospitalVicenzaItaly
  2. 2.The Healthier Weight CentrePrincess Grace HospitalLondonUK
  3. 3.Obesity Unit, Department of Medical and Surgical SciencesUniversity of PaduaPaduaItaly
  4. 4.VicenzaItaly

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