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Treatment of massive super-obesity with laparoscopic adjustable gastric banding
Jonathan A Myers1, Sharfi Sarker, Vafa Shayani
1Department of Surgery, Loyola University Medical Center, Maywood, IL 60513, USA.
Background:
Controversy exists concerning the optimal treatment of patients with massive super-obesity (body mass index >60 kg/m(2)). The ideal surgical operation must balance optimal weight loss with minimal morbidity and mortality. We report our results for this patient population undergoing laparoscopic adjustable gastric banding (LAGB).
Methods:
We performed a retrospective review of all consecutive patients undergoing LAGB at our institution. Patients with a preoperative body mass index >60 kg/m(2) were identified and their charts were reviewed. Weight loss data were collected when the patients returned for band adjustments. All band adjustments were patient driven and performed under fluoroscopic guidance.
Results:
Between November 2001 and October 2004, 352 patients underwent LAGB. Of these, 53 had a preoperative body mass index >60 kg/m(2) (15%). The mean absolute weight and body mass index was 186.6 kg (range 139.6-250.6) and 66 kg/m(2) (range 60.0-79.8), respectively. The average follow-up was 12.5 months (range 1.3-31). The most prevalent co-morbidities were obstructive sleep apnea (64%), hypertension (42%), and diabetes mellitus (42%). Postoperative complications included one band removal for chronic obstruction, one band revision for slippage, and one nonfatal pulmonary embolism. The mean percentage of excess weight loss was 15% (-1.1 to 27.4) with <6 months of follow-up, 28.1% (range 1.9-44.5) with 6-12 months of follow-up, 35.1% (range 8.8-84.9) with 12-18 months of follow-up, and 42.9% (range 15.7-80.1) with >18 months of follow-up. Compared with our cohort of nonmassive super-obese patients, massive super-obese patients required a longer period of follow-up to accomplish a similar percentage of excess weight loss.
Conclusion:
LAGB is an appropriate surgical option for the treatment of massive super-obesity. The procedure can be performed with minimal morbidity and mortality and leads to promising medium-term weight loss. Longer term follow-up of massive super-obese patients is necessary and may demonstrate even more successful results.
