Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up.
BACKGROUND
LAGB is a technique increasingly used in the USA. The aim of this study is to analyze the 5-year outcome in terms of weight loss and complications.


METHODS
We reviewed our prospective electronic database for all patients undergoing LAGB between 2002 and 2007. We assessed weight progression, complications, and reoperations.


RESULTS
We performed 199 cases during this period (70.4% females). Mean age was 37.8 ± 12.4 years. Preoperative body mass index (BMI) was 36.0 ± 3.8 kg/m(2). Preoperative comorbidities were dyslipidemia in 52.3%, insulin resistance in 30.7%, arterial hypertension in 24.6%, and type 2 diabetes in 5.5%. There were no conversions to open technique. Early complications were observed in two patients (1%): one hemoperitoneum and one ileitis. Mortality was 0%. Late complication rate was 33.6% (18.0% related to the band). Reoperation was required in 40 patients (20.1%). Laparoscopic repositioning was done in seven patients, and port/reservoir revision was done in five patients. Band removal was required in 28 patients, due to inadequate weight loss in 9, slippage in 9, gastric erosion in 1, bowel obstruction in 1, acute stomach dilatation in 1, and food intolerance in 7. Twenty of these patients underwent revisional surgery: sleeve gastrectomy in 12 and laparoscopic Roux-en-Y gastric bypass in 8 cases. Unrelated band complication was seen in 15.6%, mainly due to anemia (7.5%), alopecia (4.5%), and cholelithiasis (3.5%). With a median follow-up of 48 months (1-72 months), 75, 60, and 95% of patients were available for follow-up at 1, 3, and 5 years, respectively. Mean percent excess weight loss (%EWL) at 1, 3, and 5 years was 58.8 ± 30.0%, 56.8 ± 35.0%, and 58.4 ± 46.6%, respectively. However, failure rate (%EWL <50%) at 1, 3, and 5 years was 40.4, 43.5, and 46.3%, respectively.


CONCLUSIONS
LAGB has low perioperative morbidity. However, its late complications are significant, and inadequate weight loss can be as high as 46.3% after 5 years.
Boza
Camilo
C
Department of Digestive Surgery, Hospital Clínico, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile. bozauc@med.puc.cl
Gamboa
Cristian
C
Perez
Gustavo
G
Crovari
Fernando
F
Escalona
Alex
A
Pimentel
Fernando
F
Raddatz
Alejandro
A
Guzman
Sergio
S
Ibáñez
Luis
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000706:statistics & numerical data; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult