Outcomes of Laparoscopic Adjustable Gastric Banding: A Single Institution’s Five Year Experience

Elizabeth A Dovec, MD, Robert Kelly, MD, Willie Melvin, MD, Ronald H Clements, MD, Brandon Williams, MD, Michael Holzman, MD, Naji Abumrad, MD

Vanderbilt University

Background: Laparoscopic Adjustable Gastric Banding (LAGB) is a commonly performed surgical procedure for the treatment of morbid obesity. Since its FDA approval in 2001, the procedure has gained popularity by both patients and surgeons due to the lower perioperative complication rate, as compared to other bariatric procedures. However, only limited data evaluating the long term complication rate of the LAGB is currently available. Our objective was to retrospectively examine the outcomes of LAGB at a single institution with emphasis on weight loss and complications.

Methods: Pulling from the Vanderbilt Center for Surgical Weight Loss data bank, a retrospective chart review was performed on all patients from 2008 to 2012 who underwent LAGB using the laparoscopic pars flaccida surgical technique with either the Lap Band® (Allergan) or Realize band® (Ethicon). Outcome measures included weight loss, length of hospital stay (LOS), frequency of adjustments, morbidity, mortality, rates of revision, explantation, or conversion of the LAGB to another bariatric operation.

Results: A total of 229 LAGB procedures were performed from January 2008 until June 2012. The mean age and preoperative body mass index was 46 (19-71) years and 43 ± 6 (SD) kg/m2, respectively with 85% of these patients being female. Mean operative time was 75 ± 25 (SD) minutes with minimal blood loss and average LOS was less than one hospital day. On average patients returned to clinic for band adjustments 5 times in the first year and 2 times per year thereafter. Year 1 total complication rate secondary to the operation was 10% with an overall complication rate during the study of 25%. The rate of band revision, explantation, or conversion to another bariatric procedure was 17%. Postoperative mean excess body weight loss (EBWL) was 32% with a mean follow-up time of 2.1 years. The overall mortality rate incurred during the study was 0.4%.

Conclusions: The review of outcomes for LAGB performed over a 4.5 year interval at a single institution, demonstrates both a low morbidity and mortality rate at year 1, 10% and 0.4%, respectively. However, further analysis showed that more than 50% of all reoperations and complications occur after year 1 and 17% of all patients required further operative intervention. Additionally, in this study, only 37% of patients experienced EBWL following LAGB. This may reflect low program retention rates and the need for multiple band adjustments.

Session: Poster Presentation

Program Number: P402