Diabetes Mellitus is the Most Significant Predictor of Excess Weight Loss in Laparoscopic Adjustable Gastric Banding in the Aged Population

Sarwat Ahmad, MD², Eric S Wise, MD¹, Kyle M Hocking, PhD¹, Colleen M Brophy, MD¹, Stephen M Kavic, MD². ²University of Maryland, ¹Vanderbilt University Medical Center

Introduction:

Laparoscopic adjustable gastric banding (LAGB) is a safe, effective and reversible alternative to small bowel reconstruction procedures in surgical weight loss. One of the benefits of this gastric restrictive procedure is its reduction in comorbidities, particularly diabetes mellitus (DM), concomitant with the associated loss of excess body weight. The inherent Catch-22 in LAGB patients, however, is that the presence of DM preoperatively has been proposed to adversely affect successful weight loss. The aim of this study is to assess the influence of DM in excess weight loss after LAGB in the aged population, a cohort that is both understudied and has a higher baseline prevalence of the condition.

Methods:

127 patients greater than 50 years of age who underwent LAGB from 2006-2012 at a single institution were reviewed using the Synthetic Derivative database. In addition to DM, additional factors with a previously validated association with excess weight loss were noted, including race, gender, pre-operative BMI, hypertension (HTN), psychiatric disorder and weight change in the 6 months prior to operation. End points were excess weight loss at 6 and 12 months post-operatively. Factors associated with endpoints on univariate screen (p<0.10) were incorporated into a multivariate model. P<0.05 was used to indicate statistical significance.

Results:

The mean age of the 127 patients was 60.2±5.7 years. Within the cohort, 100/127 (72.7%) patients were female, 10/127 (7.9%) were black and 63/127 (49.6%) had DM. Patients had a mean excess weight loss of 26.2±12.0% and 30.3±18.9% at 6 and 12 months post-operatively, respectively. The cohort without DM had greater 6 and 12 month excess weight loss than those without DM (29.8±12.8% vs. 22.5±9.8%, and 35.0±18.7 vs. 25.8±18.0%, respectively). In univariate analysis, black race, pre-operative BMI and DM were associated with decreased excess weight loss at 6 months; male gender, HTN, preoperative weight loss and DM were associated with a decreased excess weight loss at 12 months. In a multivariate linear regression model, negative predictors of excess weight loss were the presence of preoperative weight loss (p=0.0192) and DM (p=0.0141) at 6 months, and only DM (p=0.0023) at 12 months.

Conclusions:

The presence of DM is the primary factor preventing excess weight loss in LAGB for patients over the age of 50. This finding may provide beneficial prognostic information to aged patients considering LAGB.