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20 Laparoscopic Adjustable Gastric Banding: Outcomes

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Minimally Invasive Bariatric Surgery

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Abstract

The laparoscopic adjustable gastric band (LAGB) is a satiety inducing procedure. By initiating a prolonged period of satiation, patients eat less and weight loss is achieved. It is the safest bariatric procedure and can be performed as an outpatient.

The reported long-term (>10 years) excess weight loss (EWL) varies from 33 to 60 %. Along with this weight loss comes substantial improvement in obesity-related comorbidities and quality of life with a 50 % improvement in medium-term mortality risk. Optimal outcomes require the patient to engage in a follow-up program that focuses on patient education as well as band adjustment focused on improving satiety. While there is a significant need for revisional procedures, these revisional procedures are safe and effective, in terms of sustained weight loss and comorbidity resolution.

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Author information

Authors and Affiliations

  1. Hamilton Medical Center—Dalton Surgery Group, 1504 Broadrick Drive, Dalton, GA, 30720, USA

    Jaime Ponce M.D., F.A.C.S., F.A.S.M.B.S.

  2. Monash University Centre for Obesity Research and Education, 99 Commercial Road, Melbourne, VIC, 3004, Australia

    Wendy A. Brown M.B.B.S. (Hons), Ph.D., F.A.C.S., F.R.A.C.S.

Authors
  1. Jaime Ponce M.D., F.A.C.S., F.A.S.M.B.S.
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  2. Wendy A. Brown M.B.B.S. (Hons), Ph.D., F.A.C.S., F.R.A.C.S.
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Corresponding author

Correspondence to Jaime Ponce M.D., F.A.C.S., F.A.S.M.B.S. .

Editor information

Editors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Stacy A. Brethauer

  2. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Philip R. Schauer

  3. Department of Surgery, Health Sciences Center, University of Virginia Health System, Charlottesville, Virginia, USA

    Bruce D. Schirmer

Review Questions and Answers

Review Questions and Answers

  1. 1.

    The LAGB helps to develop early satiation by:

    1. a.

      Limiting significantly the food transit

    2. b.

      Decreasing the ghrelin levels

    3. c.

      Altering the levels of several gastrointestinal hormones

    4. d.

      Generating myoenteric pressure signals

      ANSWER: d

      Studies have shown that delay in gastric emptying is not the main mechanism of action and there is a lack of correlation between over-restriction and satiety. The band should not physically limit significantly food transit. There is negligible food found above the band after a meal with the band correctly adjusted to induce satiety. A range of hormones including insulin, leptin, ghrelin, pancreatic polypeptide, and peptide YY do not play a significant role in LAGB function. It is hypothesized that the mechanical effects of the band and the passage of food bolus through this area of band resistance can generate myoenteric pressure signals. Signals from these receptors may be important in both meal termination and satisfaction, although the functional roles of these receptors remain poorly understood.

  2. 2.

    Weight loss after LAGB:

    1. a.

      Is achieved completely during the first year after surgery

    2. b.

      Has not been documented beyond 5 years

    3. c.

      Dependent in great part to an effective follow-up program

    4. d.

      Is similar to nonsurgical medical weight loss therapy

      ANSWER: c

      Weight loss after gastric banding progresses over a 2- or even 3-year period and then stabilizes, usually in the range of between 40 and 55 % of excess weight. Several studies have documented outcomes beyond 5 years. Weight loss outcomes are correlated with a need for lifelong follow-up with regular band adjustments. There have been randomized controlled trials assessing the superior effectiveness of LAGB vs. conservative weight loss programs.

  3. 3.

    The comorbidities of obesity following LAGB:

    1. a.

      Do not change

    2. b.

      Improve substantially

    3. c.

      Do not translate to an improved mortality risk

    4. d.

      Are not associated with a cost-benefit

      ANSWER: b

      There is an improvement in all comorbidities of obesity following LAGB and this translates to an improved risk ratio for mortality as well as a cost-benefit to the community.

  4. 4.

    Revisional surgery after LAGB:

    1. a.

      Is required by an average of 28 % of patients 10 years after the primary procedure

    2. b.

      Has a higher mortality than the primary procedure

    3. c.

      Leads to poor weight loss compared with prior to the procedure

    4. d.

      Conversion to an alternative bariatric procedure should be preferred

      ANSWER: a

      While there is an 8–60 % need for revision at 10 years post LAGB, this is consistent with the reoperation rate for any bariatric procedure as well as the revision rate for other procedures performed for benign disease (reflux, joint prosthesis). Revisions can be performed safely, and the weight loss following a revision usually resumes the pre-revision trajectory. Conversion to an alternative procedure should be considered if the lower esophageal sphincter complex is ineffective [52].

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Ponce, J., Brown, W.A. (2015). 20 Laparoscopic Adjustable Gastric Banding: Outcomes. In: Brethauer, S., Schauer, P., Schirmer, B. (eds) Minimally Invasive Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1637-5_20

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  • DOI: https://doi.org/10.1007/978-1-4939-1637-5_20

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1636-8

  • Online ISBN: 978-1-4939-1637-5

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