Band and Port Complications after Adjustable Gastric BandingMonday, November 10, 2008
Laparoscopic adjustable gastric banding (LAGB) is now one of the most popular forms of bariatric surgery. Its two main advantages are surgical ease of band placement and the possibility of subsequent adjustment of band volume (and thus restriction).
Drawbacks include introduction of a foreign body, high-dependence on patients compliance and adherence, and the continuing need for band adjustments. But there are also technical issues that can arise, often requiring reoperation.
Based on a recent study by Marie-Veronique Launay-Savary and colleagues, Hôtel-Dieu, Clermont-Ferrand, France, the frequency of technical complications of adjustable gastric banding may in fact be higher than most experts think (Obesity Surgery).
Based on an evaluation of 286 consecutive patients, who underwent laparoscopic adjustable gastric banding (LAGB) between January 1997 and December 2004 at their centre, the researchers found that port or band complications (e.g. port displacements, port rupture, band rupture, etc.) occurred in around 20-30% of all patients over the mean follow-up period of 3.3 years. The mean time for complications was around 2 years post-surgery).
While there were some variations in the frequency of complications depending on which version of the LapBand was used in the study, with the exception of rupture rates, which decreased after changing the junction between port and catheter after March 2002, complication rates remained rather high.
Importantly, the study did not look at other reasons for failure such as patient non-compliance or food intolerance, that sometime also require revisional surgery – so the overall complication and failure rate is even higher than reported in this study.
Since enrollment of patients in this study, band technology and surgical experience has improved world-wide, however, there is little question that technical issues related to adjustable banding remain a significant challenge – the fact that as many as 30% of patients may require revisional surgery within 3-5 years is alarming.
This is particularly important information for patients seeking LABG surgery at private centres or out-of-country, as it is often not clear exactly who will bear the additional costs of revisional surgery (that in some cases may not only involve complete replacement of the band or conversion to bypass surgery) when necessary .
While there is no question that for many patients, LABG is a valuable and often life-changing tool with high rates of remission of obesity complications, when things go wrong (as they always will for a certain percentage of patients undergoing any kind of surgery), reoperation (with significant additional costs and complications) may be unavoidable.
Are the long-term outcomes with newer bands and more experienced centres better? Probably still too early to tell, as the technology and experience continues to rapidly evolve.
Nevertheless, the bottom line is that the decision to proceed with LABG, as with any form of bariatric surgery, always needs to be carefully considered and will clearly remain only a last resort for patients whose health is significantly affected by their excess weight.
I believe it is fair to say that anti-obesity surgery will never be safe enough to ever warrant its use for purely cosmetic indications.
Wednesday, November 12, 2008
Thanks for bringing this study to my attention. It is great to have this observation published, because we are seeing the same thing in our practice! I would like to add band erosion to the list of complications as well. It will be good to be able to cite this study when counseling patients about adjustable banding surgeries. For those patients who had done well with the band, obviously the choice was the right one. As you have noted, it is important that patients (and practitioners) are well informed when they make the decision to undergo any bariatric surgery. This study adds valuable information to the literature!!!
Wednesday, November 12, 2008
Two related recent studies are published online in October and November issues of Obesity Surgery. The titles are: “High Complication Rate after Swedish Adjustable Gastric Banding in Younger Patients ≤25 Years”, and “Results and Complications After Swedish Adjustable Gastric Banding in Older Patients”.
Thursday, November 20, 2008
I would be interested in the number of people who follow the “rules” vs. those who do not and the rate of complication. I understand that this is not possible as it is so subjective and the rules vary from doctor to doctor. I would be willing to bet thatthe number is drastically slanted to the people who break the rules and mis-use the tool that they have had put inside of them.
Just like any other tool, it only works as well as the person using it.