title: Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls.
abstract: BACKGROUND
  To compare the mortality rate of obese patients treated by laparoscopic gastric banding (LAGB) with the mortality rate of matched obese patients observed at medical centers. The net effect of bariatric surgery on total mortality is still controversial. Gastric bypass has been shown to reduce the relative risk of death, but similar data with LABG are still lacking.
  
  
  METHODS
  The surgical series was composed of 821 patients with a body mass index (BMI) >40 kg/m(2) consecutively treated with LAGB at Padova University, Italy. The reference group was composed of 821 gender-, age-, and BMI-matched patients selected from a sample of 4681 adults with a BMI >40 kg/m(2) observed at 6 Italian medical centers not using surgical therapy.
  
  
  RESULTS
  The mean follow-up was 5.6 +/- 1.9 and 7.2 +/- 1.2 years in the surgical and reference group, respectively. The vital status was known in 97.6% of the surgical group (8 deaths) and in 97.4% of the reference group (36 deaths). In the surgical group, the percentage of excess weight loss was 39.8% +/- 17.9% 1 year after LAGB and 37.2% +/- 23.8% 5 years after LAGB. The rate of late revisional surgery was 12.2%. Survival was estimated using the Kaplan-Meier method, and the differences between the 2 groups were evaluated using the log-rank test. The survival rate was significantly greater in the surgical group (P = 0.0004). On multivariate Cox analysis, the 5-year relative risk of death in the surgical group, adjusted for gender, age, and baseline BMI, was 0.36 (95% confidence interval 0.16-0.80).
  
  
  CONCLUSIONS
  LAGB was associated with a 0% operative mortality rate and 40% stable excess weight loss. LAGB patients had a 5-year 60% lower risk of death than comparable morbidly obese patients.
authors: Servizio Terapia Medica e Chirurgica dell'Obesità, University of Padova, Padova, Italy. luca.busetto@unipd.it
authors: Luca
authors: L
authors: Busetto
authors: Dario
authors: D
authors: Mirabelli
authors: Maria Letizia
authors: ML
authors: Petroni
authors: Marco
authors: M
authors: Mazza
authors: Franco
authors: F
authors: Favretti
authors: Gianni
authors: G
authors: Segato
authors: Monica
authors: M
authors: Chiusolo
authors: Franco
authors: F
authors: Merletti
authors: Franco
authors: F
authors: Balzola
authors: Giuliano
authors: G
authors: Enzi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015390:Gastric Bypass / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D015431:Weight Loss