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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2012

01-07-2012

Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States

Authors: Hadar Spivak, Mena F. Abdelmelek, Oscar R. Beltran, Amelia W. Ng, Seiichi Kitahama

Published in: Surgical Endoscopy | Issue 7/2012

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Abstract

Background

Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes.

Methods

A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%).

Results

After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5–7 years at approximately 15 kg/m2 for the LRYGB patients and at about 9 kg/m2 for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group.

Conclusions

Over the long term, LRYGB had an approximate reduction of 15 kg/m2 BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.
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Metadata
Title
Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States
Authors
Hadar Spivak
Mena F. Abdelmelek
Oscar R. Beltran
Amelia W. Ng
Seiichi Kitahama
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-2125-z

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