Outcomes with the adjustable gastric band.

BACKGROUND

The laparoscopic adjustable gastric band (LAGB) has been offered as a safe, effective, and reversible alternative to more invasive weight loss procedures.

METHODS

All LAGB procedures performed from May 2001 to July 2005 were reviewed retrospectively with respect to complications and weight loss.

RESULTS

During this time period, 186 LAGBs were placed. Average body mass index (BMI) was 43.5 kg/m2 (range, 32 to 62 kg/m2). Average age was 47.8 years (range, 18 to 76 years). Females constituted 76% of patients. Average duration of follow-up was 26.1 months, with follow-up at 1, 2, and 3 years of 96%, 76%, and 62% of patients, respectively. Average number of postoperative office visits was 11. At 1, 2, and 3 years, excess weight loss was 36%, 42%, and 42%, respectively. Of the patients, 30% did not lose more than 25% of their excess weight, and 54% did not achieve a BMI less than 35 kg/m2. The only measured predictor of improved weight loss was lower initial weight (P < .0005). The independent variables, surgeon, surgeon experience, patient age, height and sex were not predictive. Mortality rate was zero. 113 complications developed in 87 patients (47%). The 30-day re-operation rate was 2% and the overall re-operation rate was 33%. However, eliminating patients who had the older Taper I port and only examining patients with the newer Taper II port, overall complication and re-operation rates decreased to 32% and 17%, respectively. Persistent esophageal complications occurred in 16 patients (8.6%); 5 patients developed pouch dilation, and 4 developed prolapse. A total of 13 (7%) LAGBs were explanted, and 9 patients were converted to a gastric bypass.

CONCLUSION

The LAGB procedure resulted in variable weight loss and a substantial number of complications.