The largest published long term study of gastric banding has reported that the operation is a safe and effective solution for obesity, with 47% excess weight loss (EWL) after 15 years*.
A total of 3,227 patients underwent gastric banding between September 1994 and December 2011 and O'Brien and colleague Wendy Brown performed a prospective, longitudinal cohort study, measuring weight changes and documenting revisional operations.
Baseline data showed the mean age of the patients was 47.1 years and 78% were women. The mean initial weight was 121.7kg and mean initial BMI was 43.8kg/m2. In total, 919 patients completed follow-up of ten or more years and data beyond ten years were available for 714 (78%) patients.
Summary of Results
- At 10 years or more, 714 patients showed a mean excess weight loss of 47.0%*
- At 15 years, 54 patients showed an excess weight loss of 47.1%, 26 patients lost more than 50%, 15 lost 25-50% and 13 lost less than 25%*
- There was no operative mortality during the primary placement of the gastric band or during any revisional operations
Professor Paul O'Brien at the Centre for Obesity Research and Education, Melbourne, Australia said...
"These results show that when you have a significant problem with obesity, a long-term solution is available. This surgery is safe and effective, and it has lasting benefits. Substantial weight loss can change the lives of people who are obese - they can be healthier and live longer."
With regards to revisional procedures Professor O'Brien said "In treating a chronic disease such as obesity over a lifetime, it is likely that something will need to be corrected at some time in some patients. The study shows a marked reduction of revisional procedures with the introduction of the new version of the Lap-Band six years ago. Importantly, those who had revisional surgery lost as much weight in the long term as those who did not need it."
Comparison with other procedures
According to the authors, the systematic review of all bariatric procedures with ten or more years of follow-up showed greater than 50% excess weight loss for all current procedures except sleeve gastrectomy for which no 10 year data were available.
The mean excess weight loss for gastric band patients was 54.2% and for Roux-en-Y gastric bypass patients it was 54.0%*.
“Although definitive comparison is not possible because of the numerous defects within most studies, there is marked similarity in the long-term weight loss effect of gastric bypass and gastric banding” the authors write. “However, operative mortality was significantly greater with gastric bypass, all deaths being associated with open surgery.”
The results confirmed the safety of gastric banding, with one death in a total of 6,177 patients. In comparison, the six gastric bypass series that provided operative mortality figures reported 21 deaths in 2,684 patients (0.8%).
Dr David Ashton MD PhD
22nd March 2013