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gastric banding (Lap Band, Swedish Adjustable Gastric Band)

Indications: - morbid obesity; BMI > 40 - BMI > 35 with serious obesity-related comorbidities [5] - BMI > 30 with severe health problems related to obesity [6] Procedure: Laparoscopy: - an adjustable silicone band is placed laparoscopically around the stomach to form a small proximal pouch (15-30 mL) - goal is to leave a 3-4 mm stoma connecting the proximal & distal stomach - a catheter connects the band with a subcutaneous injection port, through which the size of the pouch is adjusted by infusion or aspiration of fluid - generally, 1 day of hospitalization Two devices have been described: - Lap Band - Swedish Adjustable Gastric Band Only the Lap Band has been FDA approved. Complications: 1) NO perioperative deaths reported 2) post-operative complications 10% [5] 3) gastric perforation (early complication) 4) 30 day mortality 0.1% 5) posterior band slippage (late & most common complication) [2] 6) dilation of the pouch 7) posterior slippage of the band 8) partial stomach volvulus 9) injection port malfunction 10) about 10% of patients need additional surgical procedure(s) to correct complications 11) ~20% of Medicare beneficiaries who undergo laparoscopic gastric banding need an additional band-related surgery [9] 12) certain foods may get stuck causing pain & vomiting - rice, bread, dense meats, nuts [5] 13) late complications that present as pulmonary symptoms [7] - cavitating pulmonary lesion that resolved after the gastric band was emptied {case report} [7] Management: - patients must consume < 800 kcal/day for 18-36 months & 1000-1200 kcal/day therafter Benefits: 1) overall 27% excess weight loss 2) 1/2 of excess weight in obese patients is lost in 2 years [1] 3) 35% effective at 2 years in maintaining > 50% of excess weight loss (vs 74% for vertical banded gastroplasty) 4) pregnancy is relatively safe after laparoscopic gastric banding [3] 5) laparoscopic gastric banding associated with 1/2 as much weight loss as gastric bypass, but with fewer short-term complications & long-term hospitalizations [] Notes: - sleeve gastrectomy preferred to gastric banding due to complications of band erosion & slippage [10]

Related

vertical banded gastroplasty

General

bariatric surgery

References

  1. Journal Watch 23(4):30, 2003 Zinzindohoue F et al, Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg 237:1, 2003 PMID: 12496523 - Ceelen W et al, Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg 237:10, 2003 PMID: 12496524 - Kellum JM, Gastric banding. Ann Surg 237:17, 2003 PMID: 12496525
  2. Journal Watch 24(2):19, 2004 Morino M et al, Laparoscopic adjustable silicone gastric banding versus vertical banded gastroplasty in morbidly obese patients: a prospective randomized controlled clinical trial. Ann Surg 238:835, 2003 PMID: 14631220
  3. Dixon JB, Dixon ME, O'brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol. 2005 Nov;106(5):965-72. PMID: 16260513
  4. Journal Watch, Mass Med Soc 20(18):143 (Sept) 2000 Weisner et al Raidology 216:389, 2000
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012
  6. Physician' First Watch, Dec 6, 2010 FDA Advisers Vote to Expand Lap Band Surgery to the Less Obese Massachusetts Medical Society http://www.jwatch.org - Pollack A Panel Votes to Expand Surgery for Less Obese New York Times, Dec 3, 2010 http://www.nytimes.com/2010/12/04/business/04obese.html?_r=1 - FDA NEWS RELEASE: Feb. 16, 20 FDA expands use of banding system for weight loss http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm245617.htm
  7. Czapran A et al Recurrent aspiration and upper lobe cavitation The Lancet, Early Online Publication, 22 December 2011 PMID: 22196831 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61517-1/fulltext
  8. Arterburn D et al Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Gastric Bypass. JAMA Surg. Published online October 29, 2014 PMID: 25353723 http://archsurg.jamanetwork.com/article.aspx?articleid=1919066 - Dimick JB, Finks JF The Beginning of the End for Laparoscopic Banding. JAMA Surg. Published online October 29, 2014 PMID: 25353359 http://archsurg.jamanetwork.com/article.aspx?articleid=1919064
  9. Ibrahim AM, Thumma JR, Dimick JB et al Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery. JAMA Surg. Published online May 17, 2017 PMID: 28514487 http://jamanetwork.com/journals/jamasurgery/article-abstract/2626422 - Gould JC Considering the Role of the Laparoscopic Adjustable Gastric Band. Do Not Throw the Baby Out With the Bathwater. JAMA Surg. Published online May 17, 2017. PMID: 28514460 http://jamanetwork.com/journals/jamasurgery/article-abstract/2626420
  10. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - Arterburn D et al. Comparative effectiveness and safety of bariatric procedures for weight loss: A PCORnet cohort study. Ann Intern Med 2018 Dec 4; 169:741. PMID: 30383139 http://annals.org/aim/fullarticle/2711394/comparative-effectiveness-safety-bariatric-procedures-weight-loss-pcornet-cohort-study - Puzziferri N, Wolfe BM. PCORnet bariatric surgery outcomes: Strength in numbers. Ann Intern Med 2018 Dec 4; 169:806. PMID: 30383123 http://annals.org/aim/article-abstract/2711441/pcornet-bariatric-surgery-outcomes-strength-numbers