Gastric banding an effective long-term solution to obesity
There were no deaths associated with the surgery or with any later operations that were needed in about half of the patients. About one in 20 patients had the band removed during the study period.
“In treating a chronic disease such as obesity over a lifetime, it is likely that something will need to be corrected at some time in some patients,” Professor O’Brien said.
“The study shows a marked reduction of revisional procedures with the introduction of the new version of the Lap-Band 6 years ago. Importantly, those who had revisional surgery lost as much weight in the long term as those who did not need it.”
Morbid obesity is a national health problem in most Western industrialized countries and is increasing in prevalence. It is defined as a body mass index of 35 with comorbidity or of 40 without comorbidity. Morbid obesity is difficult to manage with medical or behavioral therapy. Surgical methods of weight control (bariatric surgery), however, have been found to provide immediate and long-term reduction in weight for most patients. There are two main approaches to surgical treatment: bypass procedures based on bypassing part of the digestive tract to generate malabsorption and restrictive procedures based on stomach volume restriction. Surgical procedures are usually performed with a laparoscopic approach. The most widely accepted procedures are laparoscopic roux-en-Y gastric bypass and laparoscopic adjustable gastric banding, both of which have been endorsed by a National Institutes of Health consensus conference. Laparoscopic adjustable gastric banding is the least invasive surgical procedure and has been proposed as a primary operation for morbid obesity. The technique is simple, safe, effective, and has relatively few complications.
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Laparoscopic Adjustable Gastric Banding Surgery for Morbid Obesity: Imaging of Normal Anatomic Features and Postoperative Gastrointestinal Complications
Arye Blachar,
Annat Blank,
Nancy Gavert,
Ur Metzer,
Gideon Fluser and
Subhi Abu-Abeid
The report also included a comparison of gastric banding – which can be done as a day-surgery procedure – and more invasive types of weight-loss surgery such as gastric bypass that are high risk and require longer hospital stay. The weight loss with gastric banding, and the need for future revisional surgery, was similar to that with gastric bypass.
“Access to weight-loss surgery in Australia remains severely limited for many obese patients as relatively few cases are treated within the public health system. We are working hard to improve access,” Professor O’Brien said.
Before you decide whether laparoscopic adjustable gastric banding is your best option, you should consider both its advantages and disadvantages.
Advantages
Gastric banding is the least invasive weight loss procedure
No re-routing of the intestine
No opening of the stomach or intestine
Shorter hospital stay
Reduced recovery time
Reduced chances of nutritional deficiencies
Mortality rate is greatly reduced
No dumping syndrome associated with this surgery
Band is adjustable
Disadvantages
Potential for injury to stomach during surgery
Major complications occur at a rate of 3 -10% requiring additional surgery
Stomach erosion and slipping
Should the band become infected, surgery would be needed to replace it
“We have ample evidence that weight-loss surgery is effective, and it is unfair that half of eligible patients cannot be treated, particularly as it has been shown that gastric banding is a highly cost-effective health care measure. The stigma of obesity, and the assumption that it is the person’s fault, entrenches discrimination against people who could benefit.”
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Courtney Karayannis
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61-408-508-454
Monash University