title: Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2.
abstract: BACKGROUND
  Many mildly to moderately obese individuals with a body mass index (BMI) lower than 35 kg/m(2) have serious diseases related to their obesity. Nonsurgical therapy is ineffective in the long term, yet surgery has never been made widely available to this population.
  
  
  METHODS
  Between 2002 and 2007, 53 patients with a BMI lower than 35 kg/m(2) underwent laparoscopic adjustable gastric banding at our institution. Data on all these patients were collected prospectively and entered into an institutional review board-approved electronic registry. The study parameters included preoperative age, gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities.
  
  
  RESULTS
  The mean preoperative age of the patients was 46.9 years (range, 16-68 years), and the mean preoperative BMI was 33.1 kg/m(2) (range, 28.2-35.0 kg/m(2)). Of the 53 patients, 49 (92%) had at least one obesity-related comorbidity. The mean BMI decreased to 28.1 +/- 2.4 kg/m(2), 25.8 +/- 2.9 kg/m(2), and 25.8 +/- 3.1 kg/m(2) and mean %EWL was 48.3 +/- 17.6, 69.9 +/- 28.0, and 69.7 +/- 31.7 at 0.5, 1, and 2 years, respectively. Substantial improvement occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive sleep apnea, hypercholesterolemia, and osteoarthritis. There was one slip, two cases of band obstruction (from food), two cases of esophagitis, and two port leaks, but no mortality.
  
  
  CONCLUSIONS
  The authors are very encouraged by this series of low-BMI patients who underwent laparoscopic adjustable gastric banding. Their weight loss has been excellent, and their complications have been acceptable. Their comorbidities have partially or wholly resolved. With further study, it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m(2).
authors.affiliation: NYU School of Medicine, New York, NY, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Sultan
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.forename: Heekoung
authors.initials: H
authors.lastname: Youn
authors.forename: Marina
authors.initials: M
authors.lastname: Kurian
authors.forename: George
authors.initials: G
authors.lastname: Fielding
authors.forename: Christine
authors.initials: C
authors.lastname: Ren
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015897:Comorbidity; D004868:Equipment Failure; D004941:Esophagitis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult