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Obesity Surgery

, Volume 19, Issue 8, pp 1108–1115 | Cite as

Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial

  • Gitana Scozzari
  • Eleonora Farinella
  • Gisella Bonnet
  • Mauro Toppino
  • Mario MorinoEmail author
Research

Abstract

Background

Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.

Methods

A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n = 49) or LVBG (n = 51) and followed up for a minimum of 7 years.

Results

Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p < 0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p < 0.05). Late complication rates were 36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p < 0.05), 46.9% vs 43.1% at 5 years (NS), and 55.1% vs 47.1% at 7 years (NS). Late reoperation rates were 28.6% in LASGBs and 2.0% in LVBGs at 3 years (p < 0.001), 38.8% and 2.0% at 5 years (p < 0.001), and 46.9% and 7.8% at 7 years (p < 0.001). Excess weight loss in LASGBs was 41.8% at 3 years, 33.2% at 5 years, and 29.9% at 7 years; excess weight loss in LVBGs was 60.9%, 57%, and 53.1%, respectively (p < 0.05).

Conclusions

This study demonstrates that in a carefully selected group of patients, LVBG is significantly more effective than LASGB in terms of late complications, late reoperations, and long-term results on weight loss.

Keywords

Adjustable silicone gastric banding Vertical banded gastroplasty Laparoscopy Bariatric surgery Obesity surgery Long-term results 

References

  1. 1.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.CrossRefGoogle Scholar
  2. 2.
    Rosenthal RJ, Szomstein S, Kennedy CI, et al. Laparoscopic surgery for morbid obesity: 1, 001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic, Florida. Obes Surg. 2006;16(2):119–24.CrossRefGoogle Scholar
  3. 3.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.CrossRefGoogle Scholar
  4. 4.
    Pratt GM, Learn CA, Hughes GD, et al. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc. 2009;23:795–9.CrossRefGoogle Scholar
  5. 5.
    Rivas H, Martínez JL, Delgado S, et al. Current attitudes to the laparoscopic bariatric operations among European surgeons. Obes Surg. 2004;14(9):1247–51.CrossRefGoogle Scholar
  6. 6.
    Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg. 1996;171(1):74–9.CrossRefGoogle Scholar
  7. 7.
    Fox SR, Oh KH, Fox K. Vertical banded gastroplasty and distal gastric bypass as primary procedures: a comparison. Obes Surg. 1996;6(5):421–5.CrossRefGoogle Scholar
  8. 8.
    Morino M, Toppino M, Garrone C, et al. Laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity. Br J Surg. 1994;81(8):1169–70.CrossRefGoogle Scholar
  9. 9.
    Morino M, Toppino M, Bonnet G, et al. Laparoscopic vertical banded gastroplasty for morbid obesity. Assessment of efficacy. Surg Endosc. 2002;16(11):1566–72.CrossRefGoogle Scholar
  10. 10.
    Morino M, Toppino M, Bonnet G, et al. Laparoscopic adjustable silicone gastric banding versus vertical banded gastroplasty in morbidly obese patients: a prospective randomized controlled clinical trial. Ann Surg. 2003;238(6):835–41.CrossRefGoogle Scholar
  11. 11.
    Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweet versus non-sweet eaters. Ann Surg. 1987;205(6):613–24.CrossRefGoogle Scholar
  12. 12.
    Mason EE. Gastric surgery for morbid obesity. Surg Clin North Am. 1992;72(2):501–13.CrossRefGoogle Scholar
  13. 13.
    MacLean LD, Rhode BM, Forse RA. A gastroplasty that avoids stapling in continuity. Surgery. 1993;113(4):380–8.PubMedGoogle Scholar
  14. 14.
    Reinhold RB. Critical analysis of long-term weight loss following gastric by-pass. Surg Gynecol Obstet. 1982;155(3):385–94.PubMedGoogle Scholar
  15. 15.
    Metropolitan Life Foundation. Height and weight tables. New York: Metropolitan Life Insurance; 1983. p. 1–3.Google Scholar
  16. 16.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefGoogle Scholar
  17. 17.
    Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;184(6B):9S–16.CrossRefGoogle Scholar
  18. 18.
    Ashy AR, Merdad AA. A prospective study comparing vertical banded gastroplasty versus laparoscopic adjustable gastric banding in the treatment of morbid and super-obesity. Int Surg. 1998;83(2):108–10.PubMedGoogle Scholar
  19. 19.
    van Dielen FM, Soeters PB, de Brauw LM, et al. Laparoscopic adjustable gastric banding versus open vertical banded gastroplasty: a prospective randomized trial. Obes Surg. 2005;15(9):1292–8.CrossRefGoogle Scholar
  20. 20.
    Nilsell K, Thörne A, Sjöstedt S, et al. Prospective randomised comparison of adjustable gastric banding and vertical banded gastroplasty for morbid obesity. Eur J Surg. 2001;167(7):504–9.CrossRefGoogle Scholar
  21. 21.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications. Obes Surg. 1997;7(4):352–8.CrossRefGoogle Scholar
  22. 22.
    Buchwald H, Ikramuddin S. Laparoscopic adjustable gastric banding in bariatric surgery: an overview of the LAP-BAND. Introduction. Am J Surg. 2002;184(6B):1S–3.CrossRefGoogle Scholar
  23. 23.
    Balsiger BM, Poggio JL, Mai J, et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000;4(6):598–605.CrossRefGoogle Scholar
  24. 24.
    Thoreson R, Cullen JJ. Indications and results of reversal of vertical banded gastroplasty (VBG). J Gastrointest Surg. 2008;12(11):2032–6.CrossRefGoogle Scholar
  25. 25.
    Balsiger BM, Murr MM, Mai J, et al. Gastroesophageal reflux after intact vertical banded gastroplasty: correction by conversion to Roux-en-Y gastric bypass. J Gastrointest Surg. 2000;4(3):276–81.CrossRefGoogle Scholar
  26. 26.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: a comparative study of 290 patients. Obes Surg. 2005;15(1):76–81.CrossRefGoogle Scholar
  27. 27.
    Weber M, Müller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004;240(6):975–82.CrossRefGoogle Scholar
  28. 28.
    Wölnerhanssen BK, Peters T, Kern B, et al. Predictors of outcome in treatment of morbid obesity by laparoscopic adjustable gastric banding: results of a prospective study of 380 patients. Surg Obes Relat Dis. 2008;4(4):500–6.CrossRefGoogle Scholar
  29. 29.
    Silecchia G, Bacci V, Bacci S, et al. Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up. Surg Obes Relat Dis. 2008;4(3):430–6.CrossRefGoogle Scholar
  30. 30.
    Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16(7):829–35.CrossRefGoogle Scholar
  31. 31.
    Tolonen P, Victorzon M, Mäkelä J. 11-year experience with laparoscopic adjustable gastric banding for morbid obesity—what happened to the first 123 patients? Obes Surg. 2008;18(3):251–5.CrossRefGoogle Scholar
  32. 32.
    Jan JC, Hong D, Bardaro SJ, et al. Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery. Surg Obes Relat Dis. 2007;3(1):42–50.CrossRefGoogle Scholar
  33. 33.
    Nocca D, Aggarwal R, Blanc P, et al. Laparoscopic vertical banded gastroplasty. A multicenter prospective study of 200 procedures. Surg Endosc. 2007;21(6):870–4.CrossRefGoogle Scholar
  34. 34.
    Magnusson M, Freedman J, Jonas E, et al. Five-year results of laparoscopic vertical banded gastroplasty in the treatment of massive obesity. Obes Surg. 2002;12(6):826–30.CrossRefGoogle Scholar
  35. 35.
    Näslund E, Freedman J, Lagergren J, et al. Three-year results of laparoscopic vertical banded gastroplasty. Obes Surg. 1999;9(4):369–73.CrossRefGoogle Scholar
  36. 36.
    Kalfarentzos F, Kechagias I, Soulikia K, et al. Weight loss following vertical banded gastroplasty: intermediate results of a prospective study. Obes Surg. 2001;11(3):265–70.CrossRefGoogle Scholar
  37. 37.
    Balsiger BM, Murr MM, Poggio JL, et al. Bariatric surgery. Surgery for weight control in patients with morbid obesity. Med Clin North Am. 2000;84(2):477–89.CrossRefGoogle Scholar
  38. 38.
    Howard L, Malone M, Michalek A, et al. Gastric bypass and vertical banded gastroplasty—a prospective randomized comparison and 5-year follow-up. Obes Surg. 1995;5(1):55–60.CrossRefGoogle Scholar
  39. 39.
    Wang W, Yu PJ, Lee YC, et al. Laparoscopic vertical banded gastroplasty: 5-years results. Obes Surg. 2005;15(9):1299–303.CrossRefGoogle Scholar
  40. 40.
    del Amo DA, Díez MM, Guedea ME, et al. Vertical banded gastroplasty: is it a durable operation for morbid obesity? Obes Surg. 2004;14(4):536–8.CrossRefGoogle Scholar
  41. 41.
    Pérez N, Baltasar A, Serra C, et al. Comparative analysis of vertical banded gastroplasty and duodenal switch at five years follow-up. Obes Surg. 2005;15(7):1061–5.CrossRefGoogle Scholar
  42. 42.
    MacLean LD, Rhode BM, Forse RA. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery. 1990;107(1):20–7.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Gitana Scozzari
    • 1
  • Eleonora Farinella
    • 1
  • Gisella Bonnet
    • 1
  • Mauro Toppino
    • 1
  • Mario Morino
    • 1
    Email author
  1. 1.Digestive Surgery and Center for Minimal Invasive Surgery Department of SurgeryUniversity of TurinTurinItaly

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