Long term study of gastric banding

Professor Franco Favretti (my surgeon!) has published a paper reporting the results of the most long term study of gastric band patients ever conducted. The study is based on monitoring the outcome of 1791 gastric band patients over a 12-year period. The paper reports on the incidence of post-operative complications, weight loss, remedial surgery and the like. You can access a .pdf file of the full article at the following address: http://www.healthierweight.co.uk/research/gastric-band-articles/study-of-gastric-band-patients-12-years-on/

Here are a few of the findings:

1. Conversion during surgery from keyhole to open surgery was 1.7%.
2. Additional surgery (i.e. during the banding procedure) was performed in 11.9% of cases (including 2.4% hiatus hernias and 7.8% cholecystectomy*).
3. Post-operative surgery was performed in 5.9% of cases (including 3.7% band removal and 2.7% band re-positioning).
4. Port-related complications occurred in 11.9% of cases.
5. There were no mortalities.
6. The average % excess weight loss (%EWL) over a ten period lies between 35 and 40% (depending on how obese the people were to start with).
7. Life expectancy is increased by 60% on average, compared with obese people who did not have LAGB surgery.

*Removal of the gall bladder

The study concludes that "the LAGB is safe and effective for the treatment of both morbidly obese and superobese patients in the short, medium and long term. In experienced hands, the complication rate is low and stable weight loss to at least 12 years has occurred" (Favretti et al 2007).

The full reference for the article is:
Favretti, F., Segato, G., Ashton, D., Busetto, L., De Luca, M., Mazza, M., Ceoloni, A., Banzato, O., Calo, E. and Enzi, G. 2007. Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results. Obesity Surgery 17, 168-175.

None of this surprises me, except one thing - number 6 above. I was told that the average % excess weight loss was between 55 and 60%. I have certainly seen other articles where these figures have been reported. Personally, I have never been satisfied with the thought of less than 10% excess weight loss - only 35-40% would still leave morbidly obese. Better than nothing, I suppose, but still very disappointing. This study only reports the findings for morbidly and super-obese people - so I supose it is possible that the results could be better for obese people (morbidly obese is BMI more than 40). However, super-obese people appear to do better in this study than morbidly obese people - so this seems unlikely.

What is also suprising is that the average %EWL is actually 38.5 +/- 27.9. What this means is that there is enormous variation between the cases studied and that while some people actually do considerably better than this, others do much worse. Looking at these figures, some people, after TEN YEARS, only lose about 10% of their excess weight!!! So, if you started out at say 20 stone and you were 10 stone overweight - you would only have lost one stone over ten years.

One of the authors is my consultant - Dr David Ashton. I will ask him about these figures when I see him next and report back!!! ....or I might even drop him an email!

On the plus side, LAGB increases life expectancy and considerably reduces the incidence of a wide range of obesity-related diseases such as diabetes. So it's not all bad by any means. I certainly have no regrets!