Prospective study of a two-stage operative concept in the treatment of morbid obesity: primary lap-band followed if needed by sleeve gastrectomy with duodenal switch.
BACKGROUND
We investigated the success rate of a two-stage operative concept for treatment of morbid obesity: primary laparoscopic adjustable gastric banding (LAGB, Lap-Band) for all morbidly obese patients, followed by sleeve gastrectomy with biliopancreatic diversion (duodenal switch or DS) in case of failure.


METHODS
From Dec 1996 to May 2004, 366 consecutive patients (female 78%, mean age 41 (17-66) years, BMI 44.3 (35-75) kg/m2 were prospectively evaluated, using the two-stage operative concept. The follow-up rate after a mean of 4.1 (1-8.4) years was 98%. Primary outcome measure was BAROS score, defined according to weight loss, quality of life, reduction in co-morbidities, complications and re-operations.


RESULTS
A very good-to-excellent result was found in 118 patients (32%), 141 (39%) had a good results, 76 (21%) a fair result, and 31 (8%) were failures. 39 patients needed re-banding due to slippage, 68 a DS, and 11 patients had band removal. Early morbidity of the Lap-Band was 3.8%, that of DS 13%, and mortality was zero. The excess weight loss at last follow-up of all the patients was 44% (40% after Lap-Band/rebanding, and 82% 2 years after DS).


CONCLUSIONS
The two-stage concept with primary LAGB, followed by DS in case of failure, leads to a good result in 71% of morbidly obese patients. LAGB alone does not appear to be an adequate procedure for every morbidly obese patient.
Peterli
Ralph
R
Department of Surgery, St. Claraspital, Basel, Switzerland. Ralph.peterli@claraspital.ch
Wölnerhanssen
Bettina K
BK
Peters
Thomas
T
Kern
Beatrice
B
Ackermann
Christoph
C
von Flüe
Markus
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss