Rise and Fall of Lap Gastric Band

1993 - Enthusiasm for the LapBand in Europe
Simple, Safe, Somewhat effective
10 years Later: Attraction Fading in Europe
Rising Complication Rates
Declining Weight Loss
Surgeons “Voting with Their Feet”
1998 Ratio Band/RNY = 20/1
2004 Ratio Band/RNY = 1/4
 

Early History

In the early 1990’s Lap Gastric Banding swept Europe
New, safer, simpler, minimally invasive treatment for Morbid Obesity
Wide adoption of Lap Gastric Banding
10 years later the “Bloom is off the rose”
Surgeons migrating their practice to gastric bypass surgery
 

Lap Gastric Band Failure

First long term Lap Gastric Band study by Camerini et al
Reported >75% band complication rate!
The rate of long term complications increase steadily and linearly over time
Once you have the Band every year that goes by more and more people suffer from more and more complications

New Study Shows Lap Gastric Band Failures

Suter et al report on the 10 year follow up of over 300 LapBand patients
Only the second report of long term LGB follow up
Findings:
Over 1/3 had Complications
Major Reoperation in ¼
40% Weight Loss Failure at 5 yrs
100,000 Lap Gastric Bands
Worldwide in 2006 aver 100,000 people have Lap Gastric Bands implanted in them

According to Suter’s paper 25,000 of these people will have Major complications in the next 5-10 years!
 

Failure of Weight Loss

The purpose of weight loss surgery is weight loss
Suter’s study and others show the high failure rates of Lap Gastric Band
Loss of less than 50% of the excess body weight is present in over 40% of patients
 

Failure of Vertical Banded Gastroplasty

The vertical banded gastroplasty has largely been abandoned
Longer term, less favorable outcomes have been reported

Initial results in terms of weight loss, complications and improvement in comorbid conditions were good
These results deteriorated over time.


MacLean et al reported failures in 48% of patients
36% underwent re-operation.

Balsiger et al reported poor weight loss following VBG at 10 or more years post procedure.

Arribas del Amo and colleagues further illustrate longer term deterioration in outcomes.

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Warning: Gastric Bypass Surgery is a MAJOR surgical procedure. It can be associated with significant risks and complications, up to and including death. Weight loss surgery is a rapidly developing area of medicine. Bariatric surgery is filled with controversy. It is very important to take a careful and deliberate approach to considering surgery for the treatment of obesity.  

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