Predictability of outcome in laparoscopic gastric banding.
BACKGROUND
The success rate of laparoscopic adjustable gastric banding (LAGB) in the treatment of morbid obesity is very variable.A reasonable preoperative selection of eligible patients seems to be important for a successful outcome of LAGB. In the present study, criteria were investigated to predict the outcome of LAGB.


METHODS
85 morbidly obese patients were operated with LAGB between 1999 and 2005. 71 of these patients were analysed according to several possible predictive parameters of success or failure of LAGB. Success was defined as excess body weight loss(EBWL) > 50% without band removal, failure was defined as EBWL < 20% and/or band removal. Median follow-up was 27 months (range 8-90 months).


RESULTS
After LAGB a median EBWL of 43% (-41 to 171.5%) was observed in all patients with a decrease in BMI of 8.0 kg/m2 (-9 to 35 kg/m2). The success rate after LAGB was 37%, the failure rate 19.7%. Female sex(p = 0.023), baseline weight (p = 0.024), and eating behaviour after LAGB (p = 0.008) were significant predictors of success following LAGB, whereas complications such as port dislocation and reoperation after LAGB did not have a significant impact on a successful course following LAGB. Significant predictors of failure were male sex (p = 0.038) and missing physical activity after LAGB (p = 0.045), whereas the eating behaviour did not have a significant effect concerning failure following LAGB. Baseline excess body weight (EBW) was identified as an independent predictor of failure in a multivariate analysis.


CONCLUSIONS
According to the results of this study, female patients with a lower EBW who improve their postoperative eating behaviour have the best chance of success following LAGB.
Thalheimer
Andreas
A
Department of General Surgery, University of Wuerzburg Hospital, Wuerzburg, Germany. Thalheimer_A@chirurgie.uni-wuerzburg.de
Bueter
Marco
M
Wierlemann
Alexander
A
Lager
Caroline
C
Jurowich
Christian
C
Germer
Christoph-Thomas
CT
Fein
Martin
M
D015992:Body Mass Index; D016009:Chi-Square Distribution; D020878:Device Removal; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008019:Life Style; D016015:Logistic Models; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss