Systematic review of laparoscopic adjustable gastric banding in patients with body mass index ≤35 kg/m².
BACKGROUND
Recently, the Food and Drug Administration (FDA) panel approved laparoscopic adjustable gastric banding (LAGB) in patients with a body mass index (BMI) ≥30 kg/m(2) and related co-morbidities. To our knowledge there is no systematic review assessing LAGB in this group. The objective of this study was to analyze the use of LAGB in patients with BMI ≤35 kg/m(2).


METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to systematically search MEDLINE and Embase using the medical subject headings (MeSH) terms "bariatric surgery" and "obese" with equivalent free text searches and cross-references. Studies that described LAGB in patients with BMI ≤35 kg/m(2) were reviewed with particular focus on weight loss after LAGB as well as morbidity/mortality, co-morbidity resolution.


RESULTS
Six studies evaluating 515 patients were included. Mean percentage excess weight loss (%EWL) ranged from 52.5 (±13.2) to 78.6 (±9.4) at 1 year and 57.6 (±29.3) to 87.2 (±9.5) at 2 years postoperatively. Two studies reported weight loss at 3 years with mean %EWL of 53.8 (±32.8) to 64.7 (±12.2). The only study with follow-up data after 3 years reported a mean %EWL of 68.8 (±15.3) and 71.9 (±10.7) at 4 and 5 years, respectively. Thirty-four patients (6.6%) developed complications. There was 1 reported mortality (.19%), which occurred at 20 months postoperatively.


CONCLUSIONS
This systematic review shows that LAGB is well tolerated and effective in patients with a BMI ≤35 kg/m(2). There are encouraging suggestions that co-morbidities show partial or total resolution; however, a paucity of data remains in this BMI group, particularly with regard to long-term outcomes.
Bariatric Surgery Unit, Homerton University Hospital, London, United Kingdom.
Samuel
S
Adegbola
Bariatric Surgery Unit, Homerton University Hospital, London, United Kingdom.
Salim
S
Tayeh
Bariatric Surgery Unit, Homerton University Hospital, London, United Kingdom. Electronic address: sanju_agrawal@hotmail.com.
Sanjay
S
Agrawal
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004812:Epidemiologic Methods; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
BMI<35 kg/m(2); Bariatric surgery; Laparoscopic adjustable gastric banding; Low BMI; Mild obesity; Obese