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 Researchers focused on a type of weight-loss surgery known as
laparoscopic adjustable gastric banding, a minimally invasive
procedure that involves placing an inflatable belt around the upper
portion of the stomach that reduces the amount of food it can hold.
People are advised to eat portions about the size of a shot glass
post-surgery.
Nationwide, a total of 28,202 patients underwent procedures to
implant laparoscopic adjustable gastric bands (LAGB) from 2007 to
2015, the study found. Over that same period, 12,157 people had
gastric bands removed, or explanted.
Starting in 2013, though, surgeons did more procedures to take bands
out than to put them in, the study team reports in the Journal of
the American College of Surgeons.
A newer alternative in weight-loss surgery known as a laparoscopic
sleeve gastrectomy that appears to be safer and more effective may
be driving this trend, said senior study author Dr. Ninh Nguyen,
chief of the division of gastrointestinal and bariatric surgery at
the University of California, Irvine School of Medicine.
“Compared to the adjustable gastric banding, the laparoscopic sleeve
gastrectomy is associated with improved weight loss and lower
incidence of late complications,” Nguyen said by email. “The late
complication rate requiring revision (procedures) after sleeve
gastrectomy is one-fourth that of gastric banding.”
More than half of weight-loss procedures done today use the sleeve
gastrectomy, which reduces the stomach to the size of a banana,
according to the American Society for Metabolic and Bariatric
Surgery.
Procedures to remove or adjust gastric bands were associated with
longer hospital stays, a greater number of serious complications and
more admissions to intensive care units compared with operations to
implant the devices, the study found.
Researchers didn’t find any difference in death rates or costs
between implantation procedures and operations to remove or fix the
bands, with both types of surgery costing an average of $11,600 to
$12,000.
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One limitation of the study is that researchers only examined
procedures done at academic medical centers, although the authors
suggest that trends might be similar at community hospitals.
Another drawback is the lack of data explaining why bands were
removed. That makes it impossible to say if the removal happened
after complications or because patients elected to switch to a
different, newer alternative such as the sleeve gastrectomy to see
if they could achieve more weight loss.
Most often, when the gastric bands are removed it’s either because
patients couldn’t tolerate the devices being tightened or because
they didn’t lose enough weight, said Dr. Anita Courcoulas, chief of
minimally invasive bariatric and general surgery at the University
of Pittsburgh Medical Center.
Because the sleeve is still relatively new, however, it’s too soon
to say whether it will achieve better weight loss or fewer
complications over the long term, Courcoulas, who wasn’t involved in
the study, said by email.
“Enthusiasm for the sleeve as a replacement for the band should be
tempered with the knowledge that longer-term outcomes are still
sorely lacking,” Courcoulas added. “It will take time, patience, and
a dynamic evaluation of the evidence as it evolves to draw more
final conclusions about the longer-term comparative effectiveness of
bariatric procedures.”
SOURCE: http://bit.ly/2vL18Pf Journal of the American College of
Surgeons, online July 25, 2017.
[© 2017 Thomson Reuters. All rights
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