Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding

We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB).

Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately.

The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only.

With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.