Predictors of outcome in treatment of morbid obesity by laparoscopic adjustable gastric banding: results of a prospective study of 380 patients.
BACKGROUND
We investigated the outcome predictors of laparoscopic gastric banding (LAGB) for morbidly obese patients.


METHODS
From December 1996 to November 2004, a total of 380 consecutive unselected patients (78% female; median age 40 yr, range 17-66; body mass index 44.3 kg/m(2), range 35-75) were prospectively evaluated and underwent LAGB. The follow-up rate after a median of 5 years (range 1.5-9.4) was 98%. A survival model was applied, and a multivariate Cox proportional hazard model was used to calculate the hazard ratios for the influential factors.


RESULTS
Of the 380 patients, 128 (33.7%) had their bands removed. Of these 128 patients, 2.4% declined another operation, 18.2% underwent biliopancreatic diversion with duodenal switch, 7.1% underwent laparoscopic Roux-en-Y gastric bypass, and 6% underwent laparoscopic sleeve gastrectomy. The excess weight loss of the remaining 252 patients (66.3%) with a band in situ (including 21 patients after rebanding) was 40%, and only 25% reached an excess weight loss >50%. Older age, binge eating disorder, and sweet-eating behavior were predictors of a poor outcome after LAGB. In contrast, sex, primary body mass index, and co-morbidities had no influence on outcome.


CONCLUSIONS
LAGB was less successful in older patients and in patients with binge eating disorder or sweet-eating behavior. These patients might be candidates for a different bariatric procedure.
Wölnerhanssen
Bettina K
BK
Department of Surgery, St. Claraspital, Kleinriehenstrasse 30, Basel, Switzerland.
Peters
Thomas
T
Kern
Beatrice
B
Schötzau
Andy
A
Ackermann
Christoph
C
von Flüe
Markus
M
Peterli
Ralph
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002032:Bulimia / Q000150:complications; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D015431:Weight Loss