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 About one in five people required additional surgeries within about
five years of receiving a gastric band, researchers found.
"Bands have really gone out of style," said senior author Dr. Justin
Dimick, of the University of Michigan in Ann Arbor. "If you're
offered one, you should think twice about it, because most surgeons
have stopped using them."
Instead of gastric banding, an operation called a gastric bypass is
considered the gold standard for weight-loss surgery by the American
Society for Metabolic and Bariatric Surgery and the National
Institutes of Health.
Gastric bands were approved by the U.S. Food and Drug Administration
in 2001, Dimick and colleagues note in JAMA Surgery. A band is
placed around the upper part of the stomach to decrease its size,
leaving less room for food. The band's tightness can be adjusted.
Complications from the gastric band can sometimes require additional
operations, however. For example, the band can erode into the
stomach or slip down and cause an obstruction.
Estimates of the proportion of patients who undergo additional
operations after receiving a gastric band vary widely, they add,
from as few as 4 percent to as many as 60 percent.
To get a better picture of the gastric-band reoperation rate in the
United States, the researchers analyzed data from Medicare, the
publicly-funded health insurance program for the elderly and
disabled.
They studied 25,042 people who received a gastric band between 2006
and 2013. The average age was about 58, and most were white and
female.
Overall, 18.5 percent of patients needed at least one more surgery
to fix, move or remove their gastric band.
In total, 4,636 patients needed another 17,539 surgeries for their
device - an average of nearly four more surgeries per patient.
"I think it’s important to know that the reoperation rate is very
high," Dimick told Reuters Health.
By 2010, with surgeons having moved away from using gastric bands,
Medicare was spending more money on reoperations than on initial
operations to implant the devices, the researchers found.
"Right now, more bands are going out than going in," said Dimick.
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Other options for weight loss surgery include gastric sleeve and
gastric bypass. Both procedures work by surgically creating a
smaller stomach, but gastric bypass also creates a shorter small
intestine that may reduce the absorption of calories and nutrients.
The rerouting of food with a gastric bypass operation leads to
changes in hormones that help to reduce hunger, create a feeling of
fullness and reduce the risk for type 2 diabetes.
The initial cost of gastric bypass is typically more than the band
or gastric sleeve procedures due to its more invasive nature.
In an editorial accompanying the new study, Dr. Jon Gould disagrees
with the study authors' suggestion that insurance companies stop
reimbursing for gastric bands.
"A committed surgeon and program, and the ideal patient with a
similar level of commitment, are needed to achieve these best
outcomes," wrote Gould, of the Medical College of Wisconsin in
Milwaukee.
"No single bariatric procedure is appropriate for all patients," he
added.
Dimick disagreed and said keeping the band available for a few
patients may lead many others to get the device when they would have
benefited from a different procedure.
Also, he pointed out, performing a gastric bypass in a patient who
previously had a gastric band or sleeve may increase the risk of
complications, because the patient will have scar tissue from the
earlier surgery.
"I think the most interesting thing about this is that surgeons have
already voted with their feet by stop doing it in their practices,"
he said.
SOURCE: http://bit.ly/2qGbqfe and http://bit.ly/2qFDnUz JAMA
Surgery, online May 17, 2017.
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