Gastric Banding Key Is Patient Selection

Use of predictive criteria to guide patient selection led to a 50% decline in complications after laparoscopic adjustable gastric banding (LAGB) and improvement in long-term weight loss, a French investigator reported.

The complication rate declined from 19% in an unselected historical control group of LAGB patients to 9% in a selected group of patients. The mean body mass index (BMI) at 5 years was 3 kg/m2 lower in patients selected on the basis of criteria associated with successful weight loss in previous studies of LAGB, Jean-Marc Chevallier, MD, said here at the American Society for Metabolic and Bariatric Surgery.

Rates of reoperation and band removal also declined in the criteria-selected patients, said Chevallier, of Hopital Européen Georges Pompidou in Paris.

"We can conclude, on this prospective series of patients selected on predictive factors of success, that compared with our historical nonselected patients, gastric banding appeared to have a decreased complication rate, a decreased reoperation rate, and a decreased band-removal rate," he said. "This means that it is nowadays useless to publish long-term results with gastric banding compared with the older perigastric technique and older high-pressure bands and on nonselected patients."

LAGB has won favor among bariatric surgeons and their patients because of its overall low morbidity, weight-loss efficacy, and reversibility. However, several studies have demonstrated high rates of late complications, and questions have arisen regarding the long-term durability of weight loss achieved with gastric banding.

Chevallier and colleagues previously examined bariatric surgery outcomes in nationwide data collected by the French National Medical Insurance Service (Ann Surg 2007; 246: 1034-1039). They identified five factors associated with increased likelihood of successful weight loss: age <40, BMI <50, patient willingness to change eating habits, physical activity, and surgery by a team with a volume of two or more bariatric procedures a week.

LAGB surgery involves laparoscopically placing an adjustable band around the upper part of the stomach such that the stomach is partitioned into two sections.

The band is tightened creating an outlet (‘stoma’) between the tiny upper and large lower stomach. The capacity of the upper segment of the stomach ranges between 10 and 15 mL. The adjustability of the band allows the surgeon to alter the diameter of the stoma. The adjustable gastric band has an inflatable tube incorporated in it that is connected to a port anchored to the rectus abdominus muscle. The adjustable band is not inflated until at least 4 weeks after surgery in order to allow it to get anchored in position by fibrous tissue (Deitel, personal communication). Once anchored, if the patient is not losing weight then saline is injected percutaneously through the skin into the port, which in turn decreases the volume of the upper stomach by constricting the band. If the patient is losing weight too quickly the band is loosened by withdrawing saline allowing for a larger outlet. The band itself can be coated with silicone or other types of materials impregnated with silicone..