Why is Adjustable Gastric Band surgery no longer reccomened?

We no longer offer adjustable gastric banding as a bariatric surgery option. We do however accept patients (no regional restrictions) in whom the gastric band failed to achieve the desired weight loss or resulted in long-term complications.

Here are some of the scientific studies that led us to the conclusion that adjustable gastric banding surgery can no longer be recommended.


Prospective, randomized trial of Dr. R. Caiazzo et. al. – Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding to Reduce Nonalcoholic Fatty Liver Disease – A 5-Year Controlled Longitudinal Study!

Annals of Surgery Vol. 260 Issue 5 pages 893-899, 2013.

These surgeons found that the RY gastric bypass was far superior to the adjustable gastric band in improving the liver damage (including cirrhosis) caused by severe obesity 5 years after the surgery. Liver disease known as Non Alcoholic Fatty Liver Disease (NAFLD, figure D) is present in 86% of patients with severe obesity. When left untreated, it can damage the liver and result in cirrhosis (figure A) and the need for liver transplantation to save a patient’s life.

        


Prospective, randomized trial of Dr. Luigi Angrisani et. al. – Gastric bypass is better at 10 years!

Surgery for Obesity and Related Diseases Vol 9 Issue 3 pages 405-413, 2013.

These bariatric surgeons in Italy studied patients that agreed to have either a laparoscopic gastric bypass or laparoscopic gastric band based on a head/tails coin toss (thus the term “randomized trial”) in 2003. Ten years after the study, those in the gastric bypass group lost a greater percentage of the excess weight they carried (69%) compared to the band patients (46%). They also observed that 40% of the band patients required more surgery over the ensuing 10 years.


Long-term outcome study of Dr. O’Brien et. al. – the only group of researchers showing good long term weight loss results with banding, but even they have a high revision rate at 10 years after the surgery.

Ann Surg. 2013 Jan;257(1):87-94.

A total of 3,227 patients were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. The study found a 47% of excess weight loss at 15 years. A high number of revision procedures were performed-proximal pouch enlargement (26%), erosion (3.4%), and port and tubing problems (21%).


 

Long-term outcomes of laparoscopic adjustable gastric banding study of Dr. J. Himpens et. al. – this study found a high failure and revision rate in gastric band patients in Europe where band has been installed in patients since 1994.

Arch Surg. 2011 Jul;146(7):802-7.

A total of 151 consecutive patients who had had adjustable gastric band surgery between January 1, 1994, and December 31, 1997, were contacted for evaluation at the University obesity center in Brussels, Belgium.  Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. The 36 patients (51.4%) who still had their band, lost 48% of their excess weight. These results show that laparoscopic band surgery gives at most 50% chance of no complications with at best 48% excess weight lost.


What non-surgeons think. Dr. Yoni Freedhoff’s blog – Weighty Matters

Gastric Bypasses Destroy Lap-bands in Head to Head Study!


Metabolic/bariatric surgery worldwide report by Dr. Henry Buchwald

Obes Surg. 2013 Apr;23(4):427-36

The salient message of the 2011 assessment is that patients are abandoning adjustable gastric banding and are choosing sleeve gastrectomy  which has gone from 7% in 2008 to 35% in 2012. Adjustable gastric banding has fallen from 43% in 2008 to 15% in 2012. By the middle of next year banding requests are predicted to fall to less than 5%.

Patients_Eng1The salient message of the 2011 assessment is that SG (0.0% in 2008) has markedly increased in prevalence.


Choices made by our patients over the years

The graph below shows the laparoscopic bariatric surgical procedure selected by our patients since 2006.

Note the decline in gastric banding requests, whereas the requests for vertical sleeve gastrectomy are increasing.

Most of our patients chose the gastric bypass as this is our specialty.

surgerychoicesWLSpatients


Allergan makes deal to sell Lap-Band unit

Allergan Inc. (the current distributor of the Lap BandR adjustable gastric banding device) announced that it has struck a deal to sell its failed obesity treatment business. The adjustable gastric banding device has been criticized as less effective and slower to produce results than some other weight-loss procedures that have grown in popularity in recent years, such as the sleeve gastrectomy, which removes a large portion of the stomach to curb food intake. Another competitor is the Roux-en-Y gastric bypass, which shrinks the stomach and reroutes the digestive tract.

Lap-Band never lived up to Allergan’s hopes. Sales dropped sharply over several quarters, and it was hit by negative publicity after patient deaths. The Irvine-based pharmaceutical and medical device company agreed to sell the obesity unit to Apollo Endosurgery Inc. of Austin, Texas, for about~ 75 million$  (origanal cost in billions of $).