The importance of follow-up and distance from centre in weight loss after laparoscopic adjustable gastric banding

In this study we examine the importance of regular postoperative follow-up and the effect of geographical distance from the centre of follow-up on long-term weight loss after laparoscopic adjustable gastric banding (LAGB).

Between 1997 and 2009, 150 patients underwent LAGB. Postoperatively, patients were invited to attend a monthly nurse-led follow-up clinic to assess weight loss and make necessary band adjustments. Demographic data and weight loss at each follow-up appointment were prospectively entered into a database. Percent excess weight loss (%EWL), number of follow-ups per patient, and the distance each patient had to travel to the surgical centre were calculated.

One hundred thirty-seven females and 13 males with a median age of 45 years, median weight of 121 kg, and median BMI of 45 have had surgery to date. Median operative time was 35 min and median length of hospital stay was 1 night. Median %EWL at 1, 3, 6, 9, 12, 24, and 36 months postoperatively was 10, 17, 26, 37, 54, 64, and 76%, respectively. Median %EWL at 12 months after LABG grouped by 1–3, 4–6, 7–9, and more than 10 follow-up attendances was 41, 48, 54, and 69%, respectively. At a median of 12 months postoperatively, at 0–10, 10–20, 20–30, and more than 30 miles from the centre of follow-up, median %EWL was 54, 57, 52, and 49%, respectively, and median number of follow-up attendances at those distances was 10, 8, 5, and 5, respectively.

With good local follow-up, weight loss after LABG can rival that achieved with more invasive procedures. Follow-up is an important determinant for weight loss after LABG. Patients attend fewer follow-up clinics with increasing distance from the centre of follow-up.