Dividing Fact From Fiction

Adjustable Gastric Band vs. Other Weight Loss Surgery Options

NOTE: Surgeons report that at 5 years many LAP-BAND and Gastric Bypass patients achieve comparable excess weight loss (55% for LAP-BAND and 59% for Gastric Bypass.)

Data include all published series with initial recruitment of at least 50 patients with follow-up of 3 years or more. There were 8 RYGB studies and 7 LAGB studies. See references.

"Lap-Band® Is Not For Sweet-Eaters"

FALSE

There is no data suggesting LAP-BAND does not work with sweet-eaters. Research suggests sweet-eating behavior should not be a contraindication for the LAP-BAND.

1. Stephen M. Hudson, John B. Dixon, Paul E. O'Brien, "Sweet-Eating is not a predictor of Outcome after LAP-BAND Placement. Can we Finally Bury the Myth?" Obesity Surgery, 12,789-794, 2002

Conclusion: Sweet-eaters do not have less favorable weight outcomes following LAP-BAND surgery. Our study confirms the findings of two other major studies. Sweet eating behavior should not be used as preoperative selection criteria for bariatric surgery.

"Follow-Up Is Not Needed With Gastric Bypass"

FALSE

Gastric Bypass patients require regular follow-up due to potential for malabsorption.

1. Robert E. Brolin, "Results of Survey of Deficiencies; 73% of patients, 6 years follow up." Obesity Surgery, April 1999

Conclusion: Gastric bypass operations induce weight loss both by restriction of intake and by malabsorption of nutrients. The incidence of deficiencies after RYGB was considerably underestimated in relation to published data.   The results of the survey suggest some surgeons should increase their knowledge of postoperative metabolic deficiencies.

Skroubis G, "Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion morbid obesity." Obesity Surgery, April 1999

Conclusion: 243 morbidly obese patients underwent bariatric surgery. A variety of nutritional parameterss were measured preoperatively and compared postoperatively at 1, 3, 6, 12, 18, and 24 months, and yearly thereafter. The most common deficiencies encountered were of iron and vitamin B12. The incidence of deficiency increased with time.

"Lap-Band Provides Less Resolution Of Comorbidites"

FALSE

LAP-BAND decreases or resolves major obesity related comorbidities.

1. Dixon, Chapman, O'Brien, "Marked Improvement in Asthma after Lap-Band surgery for Morbid Obesity." Obesity Surgery, 9,385-389, 1999 Conclusion: LAP-BAND improves asthma in 60% of patients, andresolvess asthma in 35%.

2. Dixon, O'Brien, "Health Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laroscopic Adjustable Gastric Banding (n=50)." Diabetes Care, 25,358-363, 2002 Conclusion: Resolves Diabetes in 65% of patients.

3. Dixon, O'Brien, "Gastroesophageal Reflux in Obesity: The Effect of Lap-Band Placement (n=48)." Obesity Surgery, 9,527-531, 1999 Conclusion: Resolves Gastroesophageal Reflux in 75% of patients.

4. Dixon, Schacter, O'Brien, "Sleep Disturbance and Obesity (n=33)." Arch Intern Med, 161,102-106, 2002 Conclusion: Resolves Sleep Apnea in 95% of patients.

"Lap-Band Is Not For The Super Obese"

FALSE

Super obese patients experience significant weight loss and comorbidity resolution with the LAP-BAND.

1. Jerome Dargent, "Super-Obese Treated by Adjustable Gastric Banding: Is It Worthwhile? A 7 Years Experience." Abstract from the International Federation for the Surgery of Obesity (IFSO) Congress 2002

Conclusion: From our experience, we do not share the belief that super obese patients should have "stronger" procedures at first place. Even if many stay morbid obese after laparoscopic placement of a gastric band, quality of life has been improved in a vast majority. Hence the debate should be focused on a second step procedure if necessary.

2. Dixon, O'Brien, "Selecting the optimal patient for LAP-BAND placement." The American Journal of Surgery, 184, 2002 Conclusion: The super obese (BMI>50) achieved a lower %EWL at 1 year after LAP-BAND placement compared with those with BMI<50, but were no differences at the 2-, 3-, and 4-year follow-ups. 3. G. A.   Fielding, "Laparoscopic adjustable gastric banding for massive super-obesity." /Surgical Endoscopy/, 2003; 17: 1541-1545

Conclusion: Weight loss with the LAP-BAND in this group of massive super obese patients has been similar to all other surgical techniques with reduction of BMI from 69 to 33 kgs/m2 at 3 years. The relative safety of the LAP-BAND avoids bowel surgery in these very big patients, suggesting that laparoscopic adjustable gastric banding is a valid surgical approach to these difficult patients.

"Lap-Band Limits Quality Of Life Compared To Gastric Bypass"

FALSE

LAP-BAND improves the quality of life by reduction in comorbidities, improved body image, and improved health associated with weight loss.

1. Dixon, O'Brien, "Changes in comorbidities and improvements in quality of life after Lap-Band placement." The American Journal of Surgery, 184, 51S-54S, 2002

Conclusion: Severe obesity is accompanied by increased mortality, medical morbidity, impaired QOL, and psychosocial disturbance. Surgical intervention using the LAP-BAND has provided a safe and effective method of achieving and sustaining significant weight loss for a majority of severely obese subjects. There is a growing body of evidence demonstrating the powerful beneficial effect of sustained weight loss following LAP-BAND surgery on obesity coromorbidity and QOL. This evidence provides perhaps the most compelling data regarding the value of LAP-BAND surgery.

2. John B. Dixon, Mareen E. Dixon, Paul E. O'Brien, "Quality of Life after LAP-BAND Placement: Influence of Time, Weight Loss, and Comorbidities." Obesity Research, November 2001

Conclusion: Severely obese subjects have poor health related QOL as measured by the SF-36 health survey. LAP-BAND surgery for this group provided a dramatic and sustained improvement in all measures of the SF-36.

3. John B. Dixon, Mareen E. Dixon, Paul E. O'Brien, "Body Image: Appearance Orientation and Evaluation in the Severely Obese, Changes with Weight Loss." Obesity Surgery, 12, 2002

Conclusion: Major improvements in appearance evaluation occur with weight loss after surgery and this is associated with psychological benefit. Study was done with 322 LAP-BAND patients.

GENERAL REFERENCES

1. Robert E. Brolin, "Survey of Vitamin and Mineral Supplementation after Roux-en-Y Gastric Bypass and after Biliopancreatic Diversion for Morbid Obesity." Obesity Surgery, 1999

2. G. Skroubis, "Comparison of Nutritional Deficiencies after Roux-en-Y Gastric Bypass and after Biliopancreatic Diversion with Roux-en-Y Gastric Bypass."Obesity Surgery, 2002

3. Barry L. Fisher M.D., Philip Schauer, M.D., "Medical and Surgical Options in the Treatment of Severe Obesity." American Journal of Surgery 2002; 184: 9S-16S

4. Executive summary: Laparoscopic Adjustable Gastric Banding for the Treatment of Obesity (Update and Re-appraisal). "The Australian Safety and Efficacy Register of new Interventional Procedures - Surgery" (ASERNIPS) 2002: 1. (Laparoscopic adjustable gastric banding surgery, like the Lap-Band surgery, is associated with a mean short-term mortality rate of around 0.05% compared to 0.50% for Gastric Bypass and 0.31% for Vertical Banded Gastroplasty).

5. Harvey J. Sugarman, M.D., "Bariatric Surgery for Severe Obesity."Journal of the Association for Academic Minority Physicians, 2001; 12

REFERENCES FOR % EXCESS WEIGHT LOSS: LAGB vs RYGB

LAP-BAND STUDIES:

1. Belachew, et al. "Long Term Results of Laparoscopic Adjustable Gastric Banding Surgical Technique."J of Laperoend & Adv Surg Techniques 2003; 13(4): 257-263

2. O'Brien, etal. "Weight loss and early and late complications - the international experience." American Journal of Surgery 2002; 184:42S-45S

3. Favretti, et al. "Laparoscopic Lap-Band, A 7-Year Experience Involving 830 Patients" (Abstract). Obesity Surgery 2000; 10:143

4. Vertruyen, M. "Experience with Lap-Band System Up to 7 Years." Obesity Surgery 2002; 12:569-572

5. Dargent, J. "Laparoscopic Adjustable Gastric Banding: Lessons from the First 500 Patients in a Single Institution." Obesity Surgery 1999; 9:446-452

6. Zinzindohoue, F. "Laparoscopic Gastric Banding: A Minimally Invasive Surgical Treatment for Morbid Obesity: Prospective Study of 500 Consecutive Patients." Annals of Surgery 2003; 1:1-9

7. Rubenstein, R. "Laparoscopic Adjustable Gastric Banding at a U. S. Center with up to 3 Year Follow-Up." Obesity Surgery 2002; 12:380-384

GASTRIC BYPASS STUDIES:

1. Pories, W. J. "Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus."Annals of Surgery 1995; Vol. 222(3):339-352

2. Freeman, J. B. "Weight Loss after Extended Gastric Bypass." Obesity Surgery 1997; 7(4):337-344

3. Jones, K. B. "Experience with the Roux-en-Y Gastric Bypass and Commentary on Current Trends." Obesity Surgery 2000; 10(2):183-185

4. Schauer, P. R. "Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity." Annals of Surgery 2000; 232(4):515-529

5. Rutledge, R. "The mini-gastric bypass: Experience with the first 1,264 cases." Obesity Surgery 2001; 11(3):276-280

6. Smith, S. C. "Changes in Diabetic Management after Roux-en-Y Bypass." Obesity Surgery 1996; 6(4):345-348

7. Capella, J. F., and Capella, R. F. "The weight reduction of choice - vertical banded gastroplasty of gastric bypass." American Journal of Surgery 1996; 171(1):74-79

8. Fox, S. R.; Oh, K. H.; and Fox, K. "Vertical banded gastroplasty and distal gastric bypass as primary procedures - a comparison." Obesity Surgery 1996; 6(5):421-425

Content Credit: INAMED HEALTH