Laparoscopic adjustable gastric banding: lessons from the first 500 patients in a single institution

Laparoscopic adjustable gastric banding (LAGB) has been adopted by many bariatric surgeons. It remains under scrutiny, although it represents a major innovation in the treatment of morbid obesity. We present the lessons from the first 500 patients treated in our institution.

From April 1995 to November 1998, 500 patients (421 females, 79 males) underwent an LAGB in our institution: 432 were morbidly obese and 68 were superobese. Mean body mass index (BMI) was 43, and mean excess weight was 51 kg.

There have been no deaths. There was one case of gastric perforation reoperated on and three cases of pulmonary and/or abdominal collections treated by drains. Two rings were changed for leakage. One ring was removed for a postoperative sigmoiditis. Three late gastric erosions occurred, requiring removal of the ring. Five access- ports have been removed for infection. 25 cases (5%)of pouch dilatation have been observed of which 18 (3.6%) led to reoperation. Mean follow-up was 21 months. Mean excess weight loss was 56% at 1 year, 65% at 2 years, and 64% at 3 years.

This favorable outcome led us to propose laparoscopic banding to all our patients instead of stapling gastroplasty. Short-term data should be confirmed by a longer follow-up, but indicate that LAGB should provide good results in terms of weight loss and that there are a limited number of failures. We believe that it should not be regarded just as a first-step procedure but as a final therapy, even for superobese patients.