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Long-Term Outcomes After Bariatric Surgery: Fifteen-Year Follow-Up of Adjustable Gastric Banding and a Systematic Review of the Bariatric Surgical Literature

O'Brien, Paul E. MD, FRACS; MacDonald, Leah PhD; Anderson, Margaret BHIM; Brennan, Leah PhD, MApp Sci; Brown, Wendy A. MBBS, PhD, FRACS

doi: 10.1097/SLA.0b013e31827b6c02
Original Articles

Objective: To describe the long-term outcomes after laparoscopic adjustable gastric banding (LAGB) and compare these with the published literature on bariatric surgery.

Background: Because obesity is a chronic disease, any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective. Yet for bariatric surgery, few long-term weight loss data are available. We report our 15-year follow-up data after LAGB and provide a systematic review of the peer-reviewed literature for weight loss at 10 years or more after bariatric surgical procedures.

Methods: We performed a prospective longitudinal cohort study of LAGB patients using an electronic database system (LapBase) to track progress, measure weight changes, and document revisional procedures. The evolution of the LAGB procedure was recognized, and revisional rates for 3 separate periods between September 1994 and December 2011 were described. In addition, we performed a systematic review of the peer-reviewed published literature collecting all reports that included weight loss data at or beyond 10 years.

Results: A total of 3227 patients, with a mean age of 47 years and a mean body mass index of 43.8 kg/m2, were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. Follow-up was intact in 81% of patients overall and 78% of those beyond 10 years. There was no perioperative mortality for the primary placement or for any revisional procedures. There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. Revisional procedures were performed for proximal enlargement (26%), erosion (3.4%), and port and tubing problems (21%). The band was explanted in 5.6%. The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years. The revision group showed a similar weight loss to the overall group beyond 10 years. The systematic review of all bariatric procedures with 10 or more years of follow-up showed greater than 50% EWL for all current procedures. The weighted mean at maximum follow-up for LAGB was 54.2% EWL and for Roux-en-Y gastric bypass was 54.0% EWL.

Conclusions: The LAGB study from 1 center demonstrates a durable weight loss with 47% EWL maintained to 15 years. This weight loss occurred regardless of whether any revisional procedures were needed. A systematic review shows substantial and similar long-term weight losses for LAGB and other bariatric procedures.

The weight loss and revisional procedures of more than 3000 patients with up to 15 years of follow-up after gastric banding are described. For comparison, a systematic review of the weight loss and revision rates of all bariatric procedure with at least 10 years of follow-up is included.

From the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia.

Reprint: Paul E. O'Brien, MD, FRACS, Centre for Obesity Research and Education, Monash University at The Alfred Centre, 99 Commercial Rd, Melbourne 3004, Victoria, Australia. E-mail: paul.obrien@monash.edu.

The Centre for Obesity Research and Education at Monash University receives a grant from Allergan Inc and Applied Medical for research and educational support. The grants are not tied to any specified research projects, and the grantors have no control of the protocol, analysis, and reporting of any studies. Dr Brown received an honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009. Dr O'Brien has written a patient information book titled “The Lap-Band Solution: A Partnership for Weight Loss”: some are given to patients without charge, some are sold to surgeons, and he receives a royalty for others. He is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility, based in Dallas, TX, that treats obesity predominantly by gastric banding.

Disclosure: Supported by the Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.

© 2013 Lippincott Williams & Wilkins, Inc.