Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure

doi:10.1016/j.amjsurg.2004.06.038

The American Journal of Surgery

Volume 189, Issue 1, January 2005, Pages 27-32

https://doi.org/10.1016/j.amjsurg.2004.06.038 Get rights and content

Abstract

Background

Obesity and its related illness is a primary health concern today.

Methods

Five hundred morbidly obese patients (mean age 42 years; mean preoperative weight 123 kg) underwent laparoscopic adjustable gastric banding surgery in a private U.S. hospital setting within a comprehensive multidisciplinary bariatric program. Patients were followed up to 36 months. Comorbidity status was assessed for 163 patients who completed ≥18 months’ follow-up by comparing medications (type and dosage) prescribed for each comorbid condition before surgery and at follow-up.

Results

At 36 months after surgery, mean body mass index (BMI) had decreased from 45.2 to 34.9 kg/m² and mean percent excess weight loss (%EWL) was 47%. Complications were as follows: gastric pouch dilatation (6.8%), slippage (2.8%), and stoma obstruction (0.6%). There was no mortality. Resolution or improvement of comorbidities were as follows: gastroesophageal reflux disease (GERD) (87%; usually immediately postsurgery), asthma (81.8%), diabetes (66%), dyslipidemia (65.5%), hypertension (48%), and sleep apnea (33%).

Conclusions

Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.

Section snippets

Materials and methods

Between November 2000 and September 2003, 500 patients (432 women) underwent gastric banding placement by a single surgeon at our facilities in the Houston, TX, area. Follow-up was extended until February 2004. Ninety percent of patients were available for 2- and 3-year follow-up. The mean age of patients was 42 years (range 18 to 63 years). The mean preoperative body weight was 123 kg (range 93 to 192 kg) and the mean body mass index (BMI) was 45.2 kg/m² (range 35 to 61).

Results

Mean operative time was 42 minutes (range 23 to 86 minutes), including the time required for additional procedures, such as cholecystectomy or repair of hiatal hernia. Mean hospital stay was 1 day (range 4 hours to 7 days). The majority of patients received 2 to 5 band adjustments (generally an in-office procedure) during the first year after surgery. Almost all patients required their first band adjustment within the first 3 months after surgery.

Comments

Laparoscopic adjustable gastric banding has been shown in many countries throughout the world to provide good weight loss and significant reduction in obesity-related illness. International experience with the gastric banding system in Europe and Australia shows a reduction in BMI of 9 to 13 kg/m² from baseline within 2 years of placement, which corresponds to about 50% to 55% %EWL [11], [12], [13], [14], [15], [16]. Weight loss continues even out to 72 months after surgery, and stablizes in

Disclosure

Hadar Spivak, MD, has served as a consultant to the medical advisory board of INAMED Health and this paper was supported in part by a research grant from INAMED Health.

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To investigate the five-year effect of weight reduction induced by BS on asthma control, quality of life and pulmonary functional parameters in severely obese intermittent or mild-to-moderate asthmatic patients.
Twenty-six consecutive severe obese subjects with previous diagnosis of asthma with indication for laparoscopic adjustable gastric banding (LAGB) were enrolled into the study. Fifteen of them agreed to undertake the surgery (treatment group, TG) while the remaining eleven non-operated patients represented the control group (CG). Body mass index (BMI), Asthma Control Test (ACT), Mini Asthma Quality of Life Questionnaire (mini-AQLQ) and spirometric parameters were evaluated at baseline and after one and five years from surgery.
Mean BMI of TG significantly decreased at one and five years after the surgery, while it remained unchanged in CG. After surgery, both the overall ACT and the mini-AQLQ score significantly improved in TG after one year, persisting improved after 5-years (p < 0.001), while these outcomes remained unchanged in CG. As compared with the pre-surgery values, the percentage of predicted FEV₁ and FVC significantly increased at five-year follow-up from surgery in TG, while it remained unchanged in CG.
In severe obese asthmatic patients, the significant improvement of asthma control test and HRQoL, observed one year after LAGB, persists five years after surgery.
Gastroesophageal Reflux Disease After Bariatric Procedures
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How to Choose and Use Bariatric Surgery in 2015
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Severe obesity is associated with increased morbidity and mortality and represents a major health care problem with increasing incidence worldwide. Bariatric surgery, through its efficacy and improved safety, is emerging as an important available treatment for patients with severe obesity. Classically, bariatric surgery has been described as either a restrictive or a hybrid surgery, which is a combination of restriction and malabsorption. For most severely obese patients, bariatric surgery results in the remission of major obesity-related comorbidities including type 2 diabetes mellitus, sleep apnea, hypertension, and dyslipidemia. Thus, bariatric surgery reduces cardiovascular risk burden, and overall mortality risk. Early complications (< 30 days) after bariatric surgery were reported to be < 10% and tend to be lower in restrictive surgeries compared with hybrid surgeries. Most common early complications reported are gastric and anastomosis leak (1.6%-5.1%), bleeding (0.5%-3.5%), and pulmonary embolism (0.2%-1%). Long-term complications (> 30 days) might differ depending on the type of bariatric surgery. According to the type of surgery and the type of study, the 30-day operative mortality rates differ from 0.1% to 1.2%. Studies on postoperative outcomes, investigations on weight loss physiology, and mechanism of action after bariatric surgery provide a better understanding of the bariatric surgery metabolic benefits. In this article, we present an overview of bariatric procedures with their effects, including risks and benefits, on the severely obese patients' health. It provides evidence to support surgical treatment of severe obesity to achieve cardiovascular disease risk reduction in severely obese patients.
L'obésité sévère est un problème de santé majeur, associée à une morbidité et à une mortalité augmentées, dont son incidence mondiale ne cesse d'augmenter. La chirurgie bariatrique est le seul traitement considéré efficace et sécuritaire pour les patients ayant une obésité sévère. Il existe 2 types de chirurgie bariatrique: 1) les chirurgies restrictives impliquant seulement une restriction à l'estomac ou 2) les chirurgies mixtes impliquant une restriction ainsi qu'une malabsorption des aliments. Pour une majorité de patients avec obésité sévère, la chirurgie bariatrique conduit à une rémission des principales comorbidités associées à l'obésité incluant le diabète de type 2, l'apnée du sommeil, l'hypertension artérielle et la dyslipidémie, contribuant ainsi à diminuer le risque cardiovasculaire et la mortalité. En général, le taux de complications à court terme (< 30 jours) est plus faible suite à une chirurgie restrictive comparativement à une chirurgie mixte et a été rapporté comme étant inférieur à 10%. Les complications à court terme (< 30 jours) les plus fréquemment rapportés sont les fuites dans l'anastomose gastrique (1,6 à 5,1%), les saignements (0,5% à 3,5%) et l'embolie pulmonaire (0,2 à 1%). Quant aux taux de complications à long terme (> 30 jours) rapportés dans la littérature, ils varient selon le type de chirurgies ainsi que le type d'étude. Le taux de mortalité post-opératoire à 30 jours varie entre 0,1 à 1,2%. Les études évaluant spécifiquement les mécanismes associés à la perte de poids et à la rémission des comorbidités associées à l'obésité sévère fournissent une meilleure compréhension des effets métaboliques de la chirurgie bariatrique et de ses complications. Cet article présente un aperçu des principales chirurgies bariatriques et résume les principaux risques et avantages de ces chirurgies sur la santé cardiovasculaire chez des patients avec une obésité sévère. Il fournit également des évidences cliniques favorables à effectuer la chirurgie bariatrique pour réduire le risque cardiovasculaire chez ces patients.

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Rapid communicationWeight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Comments

Disclosure

J Gastrointest Surg

Am J Surg

Am J Surg

Actual causes of death in the United States, 2000

JAMA

Diseases and problems secondary to massive obesity

Medical and surgical options in the treatment of severe obesity

Am J Surg

Laparoscopic gastric banding in morbidly obese adolescents

Obes Surg

Experience with Lap-Band system up to 7 years

Obes Surg

Optimization of access-port placement for the Lap-Band system

Obes Surg

Lap Band adjustable gastric banding systemthe Italian experience with 1863 patients operated on 6 years

Surg Endosc

Laparoscopic bandingselection and technique in 830 patients

Obes Surg

Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity

Obes Surg

Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients

Ann Surg

The laparoscopic adjustable gastric band (Lap-Band)a prospective study of medium-term effects on weight, health and quality of life

Obes Surg

Rapid communication
Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure