title: Safety, efficacy, and durability of laparoscopic adjustable gastric banding in a single surgeon U.S. community practice.
abstract: BACKGROUND
  Although laparoscopic adjustable gastric banding (LAGB) has been increasing in popularity, controversy is ongoing in regard to its efficacy, safety and durability. Particular concern exists now that this technique is being adapted in the community setting. We report a single surgeon's experience of LAGB in a community practice serving a medium-size Midwest town in the United States.
  
  
  METHODS
  From March 30, 2004 to December 2, 2009, 442 patients underwent LAGB (77% women; mean age 47 years, range 18-71; mean body mass index 47 kg/m(2), range 35-78). The maximal number of primary procedures performed in a 12-month period was 105. Follow-up information was available for 94% of patients.
  
  
  RESULTS
  The perioperative mortality rate was 0%. The average percentage of excess weight loss was 27% at 6 months (n = 384), 38% at 12 months (n = 301), 44% at 18 months (n = 260), 48% at 24 months (n = 190), 51% at 36 months (n = 135), 58% at 48 months (n = 66), and 60% at 60 months (n = 31). By 60 months, 10% had failed to lose ≥25% of their excess body weight. The explantation rate was 1.8%. Gastric prolapse occurred in 2.0% of patients and erosion in 0.4% of patients.
  
  
  CONCLUSIONS
  LAGB can be done safely in a community setting with acceptable weight loss and low failure rates. LAGB is less technical than other procedures; however, the results depend heavily on meticulous long-term follow-up. We have proposed a strategy that has been effective in the community setting.
authors.affiliation: Center for Advanced Laparoscopic and Bariatric Surgery, Bloomington, Indiana, USA. jbraymd@comcast.net
authors.forename: James B
authors.initials: JB
authors.lastname: Ray
authors.forename: Shahla
authors.initials: S
authors.lastname: Ray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss; D055815:Young Adult