Have the current studies finally answered the question on the effectiveness and safety of one type of gastric surgery?…
More than 200,000 weight loss surgeries are performed each year in the U.S.
Several recent studies have questioned the effectiveness and safety of one type, gastric banding, which has led to a decline in its use as patients choose other surgical options.
But the largest and longest study yet of the procedure found that patients followed for up to 15 years maintained significant weight loss — an average of about 60 pounds.
About half the patients in the study needed additional surgeries to adjust the bands or deal with other complications, but only about 1 in 20 patients opted to have the bands removed.
Paul O’Brien, MD, and researcher of Melbourne, Australia’s Monash University, is a pioneer of the Lap-Band procedure, and his latest study was supported by Allergan Inc., which markets the gastric band system.
He added that gastric banding offers an effective, reversible, long-term solution for weight loss as long as patients get good follow-up care and are educated and are willing to carefully control the way they eat.
"Placing the band is just the first step in the process," he says. "Compliance and follow-up are critically important. There are plenty of people out there doing this surgery without a follow-up program for their patients, and they are setting them up for failure."
The Lap-Band procedure is one of several weight loss surgeries performed in the U.S. and the only one that is easily reversible. The band is an inflatable silicone ring that is wrapped around the upper part of the stomach to create a pouch the size of a golf ball, which limits the amount of food that can be eaten. The band can be tightened or loosened to increase or decrease the size of the opening to the lower stomach.
The most commonly performed type of gastric bypass surgery also reduces the size of the stomach to that of a golf ball. The surgery also bypasses a section of the small intestine, which limits calorie absorption.
The gastric sleeve procedure involves the surgical removal of a portion of the stomach to create a "sleeve" that connects to the small intestine, which is not yet approved in the U.S.
Ronald H. Clements, MD who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville stated that, just a few years ago, gastric banding was widely seen as less risky, less costly, and less invasive than either of the other surgical options, and about half of weight loss procedures in the U.S. involved banding. But that has changed as the long-term data comparing weight loss surgeries has become available.
Clements says just five of the 360 weight loss surgeries performed at Vanderbilt last year were Lap-Band procedures. "We have essentially stopped doing this operation," he says. "The sleeve and the bypass are just better for helping people lose weight and keep it off. That’s what we are seeing in our patients and that’s what the data are telling us."
A 2011 study from Belgium found that the bands eroded in 1 in 3 patients, while 60% required additional surgeries. And a study published last year that compared banding to bypass surgery found that bypass patients lost more weight and kept it off over six years and had fewer complications.
Four years ago, as many as 40% of weight loss surgeries performed at Lenox Hill Hospital in New York involved gastric banding, says Mitchell Roslin, MD, who is chief of obesity surgery. Today, the figure is closer to 3%. "Last year we took out 80 bands and converted them to other procedures," he says. "Patients do well in the short term, but they tend to have problems later on."
American Society for Metabolic & Bariatric Surgery President Jaime Ponce, MD, confirms that fewer Lap-Band surgeries are being performed in the U.S. Allergan’s sales related to its Lap-Band system reportedly fell from close to $300 million in 2011 to about half that figure last year. But Ponce says the surgery is still a good option for some patients.
"The band is a device that requires a lot of maintenance and multiple adjustments, and one problem is that our insurance system is not set up to pay for this," he says. He says gastric banding is much more popular and widely performed than gastric bypass in Australia. "In Australia, aftercare is covered by national insurance, so patients don’t have to worry about paying for adjustments," Ponce says.
Ponce says patients who understand that gastric banding will require careful compliance and frequent follow-up visits to their doctor can achieve good results with the gastric banding surgery. "Patients need to be followed, preferably every month or so," he says. "If your surgeon doesn’t offer this kind of follow up, you need to go somewhere else."
Annals of Surgery, Jan. 2013