Laparoscopy Silicone Stomach Banding Not Effective For Surgical Treatment of Obesity

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Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for
Treatment of Morbid Obesity

To report the results from one of the eight original U.S. centers performing laparoscopic adjustable silicone gastric banding, a new minimally invasive surgical technique for treatment of morbid obesity. Laparoscopic adjustable silicone gastric banding is under evaluation by the Food & Drug Administration in the United States in an initial cohort of 300 patients.

Method

Of 37 patients undergoing laparoscopic placement of the Laparoscopic adjustable silicone gastric banding device, successful placement occurred in 36 from March 1996 to May 1998. Patients have been followed up for up to 4 years.

Results

Five patients (14%) have been lost to follow-up for more than 2 years but at last available follow-up (3-18 months after surgery) had achieved only 18% (range 5-38%) excess weight loss. African American patients had poor weight loss after Laparoscopic adjustable silicone gastric banding compared with whites. The Laparoscopic adjustable silicone gastric banding devices were removed in 15 (41%) patients 10 days to 42 months after surgery. Four patients underwent simple removal; 11 were converted to gastric bypass. The most common reason for removal was inadequate weight loss in the presence of a functioning band. The primary reasons for removal in others were infection, leakage from the inflatable silicone ring causing inadequate weight loss, or band slippage. The patients with band slippage had concomitant poor weight loss. Bands were removed in two others as a result of symptoms related to esophageal dilatation. In 18 of 25 patients (71%) who underwent preoperative and long-term postoperative contrast evaluation, a significantly increased esophageal diameter developed; of these, 13 (72%) had prominent dysphagia, vomiting, or reflux symptoms. Of the remaining 21 patients with bands, 8 currently desire removal and conversion to gastric bypass for inadequate weight loss. Six of the remaining patients have persistent morbid obesity at least 2 years after surgery but refuse to undergo further surgery or claim to be satisfied with the results. Overall, only four patients achieved a body-mass index of less than 35 and/or at least a 50% reduction in excess weight. Thus, the overall need for band removal and conversion to GBP in this series will ultimately exceed 50%.

Conclusion

The authors did not find Laparoscopic adjustable silicone gastric banding to be an effective procedure for the surgical treatment of morbid obesity. Complications after Laparoscopic adjustable silicone gastric banding include esophageal dilatation, band leakage, infection, erosion, and slippage. Inadequate weight loss is common, particularly in African American patients. More study is required to determine the long-term efficacy of the Laparoscopic adjustable silicone gastric banding

Source:
DeMaria EJ, Sugerman HJ, Meador JG, Doty JM, Kellum JM, Wolfe L, Szucs RA, Turner MA. Department of Surgery, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia 23298, USA. 2001

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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2008 Bariatric-Surgery.Info - Terms - Contact - Information - Resources - Add URL