Laparoscopic Adjustable Gastric Band Surgery And Long-Term Weight Loss Results
Increasingly we have seen reports in the literature from outstanding centers that demonstrate the long-term weight loss results after gastric banding surgery (Realize band and Lap-band) are equivalent to the long-term weight loss results after gastric bypass surgery. What occurs is that weight loss is more rapid and greater in magnitude in the first year after gastric bypass surgery, but this gap narrows significantly at the second year of follow-up. By the third year the difference becomes quite small and may, in fact be indistinguishable. Then in years four, five and beyond the average maintained long-term weight appears to be the same between the two groups in these studies.
In other studies from programs and centers that focus a bit less comprehensively on long-term band follow-up and care, the results after gastric bypass surgery continue to show a weight loss advantage in favor of the bypass. The gap at year one is narrowed, but even in the long-term their remains an advantage for the gastric bypass arm and of course this advantage does translate into some improvements or advantages in other health conditions such as obstructive sleep apnea, hyperlipidemia, hypertension and diabetes.
So what accounts for the difference in these studies? While we can’t be certain, and of course there is always variability in any such long-term studies looked at from different centers and different perspectives, I believe the answer may lie in the diligence with which the band patients are followed and the dedication to Lap-band follow-up exhibited by those programs.
What I mean is that patients undergoing gastric banding surgery may have two very different experiences: on the one hand they may go to a center that has outstanding long-term follow-up and have enthusiastic and knowledgeable physicians assistant, nurse practitioners and dieticians who can coach, council and encourage patients to continue their weight loss journey over the long-term while also skillfully making band adjustments in the office. The program likely also has support groups and may have other features such as special events, walking groups and celebrations. All of this combines to create an environment that is conducive to long-term weight loss success. On the other hand, the patient may go to a center where surgery is performed and very little follow-up is involved. (An extreme example would be a person who leaves the country to save money in the short-term, but fails to have taken advantage of the long-term follow-up features that lead to success.) Several studies support this notion that the level of participation in long-term follow-up and the commitment to band adjustments by both the patient and the program, are critical to long-term success.
Our program has fought to enhance its long-term, follow-up features by creating walking groups, special events, support awareness of childhood obesity prevention, a celebratory fashion show, and enthusiastic coaching and encouragement with frequent open access band fills. In the future I hope that our center might also report data which demonstrates the long-term weight loss results with gastric banding are indeed comparable to the long-term weight loss results after the outstanding results of gastric bypass surgery, which we have previously reported.