Study Adds Weight to Lap Band Risks

March 21, 2011— -- Nearly half of patients who have laparoscopic gastric banding for obesity eventually need to have the devices removed because of erosion or some other malfunction, researchers say.

Among 82 patients followed for at least 12 years after lap-band surgery at a single institution, 49 had at least one reoperation for complications or device failure, according to Dr. Jacques Himpens, of Saint Pierre University Hospital in Brussels, and colleagues.

They also reported online in Archives of Surgery that 41 had the bands removed during follow-up, with 14 then undergoing Roux-en-Y gastric bypass surgery. In all but a few cases, inadequate weight loss or device breakdown was the reason for band removal.

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"The high failure rate of laparoscopic adjustable gastric banding, at least in our hands, could be detrimental to its future continued widespread use as a restrictive weight-loss operation," Himpens and colleagues wrote.

But the researchers also found that, of 78 patients indicating their level of satisfaction with the original lap-band procedure, 60 percent said they were pleased or very pleased.

Moreover, on an intent-to-treat basis, patients in the study had lost about 43 percent of their original excess weight at follow-up, and the mean reduction in body mass index was 7.8 points.

The study involved 151 consecutive patients receiving lap-band surgery (using a device made by Bio-Enterics) from 1994 to 1997. Himpens and colleagues tried to contact them by telephone and mail, succeeding with 82.

They suggested that the patients lost to follow-up probably had lost little weight, insofar as regular post-operative evaluations and treatment are "a critical factor for success in bariatric procedures."

Among the 82 with follow-up data, 32 indicated they had suffered major complications. These included nine cases of pouch dilation (requiring band removal in six) and 23 instances of band erosion.

The latter was discovered after a mean of four years and led to band removal or gastric bypass surgery in 19 cases.