Reuters Health - Doctors are doing fewer weight-loss procedures to implant adjustable bands around the stomach and more operations to remove the devices or alter them, a U.S. study suggests.
Researchers focused on a type of weight-loss surgery known as laparoscopic adjustable gastric banding, a minimally invasive procedure that involves placing an inflatable belt around the upper portion of the stomach that reduces the amount of food it can hold. People are advised to eat portions about the size of a shot glass post-surgery.
Nationwide, a total of 28,202 patients underwent procedures to implant laparoscopic adjustable gastric bands (LAGB) from 2007 to 2015, the study found. Over that same period, 12,157 people had gastric bands removed, or explanted.
Starting in 2013, though, surgeons did more procedures to take bands out than to put them in, the study team reports in the Journal of the American College of Surgeons.
A newer alternative in weight-loss surgery known as a laparoscopic sleeve gastrectomy that appears to be safer and more effective may be driving this trend, said senior study author Dr. Ninh Nguyen, chief of the division of gastrointestinal and bariatric surgery at the University of California, Irvine School of Medicine.
“Compared to the adjustable gastric banding, the laparoscopic sleeve gastrectomy is associated with improved weight loss and lower incidence of late complications,” Nguyen said by email. “The late complication rate requiring revision (procedures) after sleeve gastrectomy is one-fourth that of gastric banding.”
More than half of weight-loss procedures done today use the sleeve gastrectomy, which reduces the stomach to the size of a banana, according to the American Society for Metabolic and Bariatric Surgery.
Procedures to remove or adjust gastric bands were associated with longer hospital stays, a greater number of serious complications and more admissions to intensive care units compared with operations to implant the devices, the study found.
Researchers didn’t find any difference in death rates or costs between implantation procedures and operations to remove or fix the bands, with both types of surgery costing an average of $11,600 to $12,000.
One limitation of the study is that researchers only examined procedures done at academic medical centers, although the authors suggest that trends might be similar at community hospitals.
Another drawback is the lack of data explaining why bands were removed. That makes it impossible to say if the removal happened after complications or because patients elected to switch to a different, newer alternative such as the sleeve gastrectomy to see if they could achieve more weight loss.
Most often, when the gastric bands are removed it’s either because patients couldn’t tolerate the devices being tightened or because they didn’t lose enough weight, said Dr. Anita Courcoulas, chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center.
Because the sleeve is still relatively new, however, it’s too soon to say whether it will achieve better weight loss or fewer complications over the long term, Courcoulas, who wasn’t involved in the study, said by email.
“Enthusiasm for the sleeve as a replacement for the band should be tempered with the knowledge that longer-term outcomes are still sorely lacking,” Courcoulas added. “It will take time, patience, and a dynamic evaluation of the evidence as it evolves to draw more final conclusions about the longer-term comparative effectiveness of bariatric procedures.”
SOURCE: bit.ly/2vL18Pf Journal of the American College of Surgeons, online July 25, 2017.