Authors' objectives:

This report has been prepared in response to a request by the Director of Professional Services of the MUHC to carry out an evaluation of the Laparoscopic Adjustable Gastric Banding (LAGB) procedure for morbid obesity, giving particular attention to its efficacy and safety, the quality of the evidence on which these evaluations are based, the costs, and how the cost compares with that of the most used alternative procedure.

Authors' recommendations: There is sufficient evidence to support the conclusion that the Laparoscopic Adjustable Gastric Band (LAGB) operation is an effective procedure with an adequate safety record for up to five years. It is widely used in North America and in Europe. Both the weight loss experienced, and the rates of mortality and morbidity associated with LAGB are fairly comparable to (or possibly lower than) the most commonly used procedure at this time, the Roux-en-Y gastric bypass. There are no randomized comparisons of the two procedures, and there is insufficient evidence on which to decide whether LAGB is a superior procedure, or not. However, according to expert opinion there are some occasions on which it would be a significantly safer procedure than LR-en-Y. Accordingly, it should become an accepted bariatric option within the MUHC, and the Qubec Healthcare system. However, until it is recognized by Qubec, neither the professional nor hospital costs for the procedure can legally be recovered from the Ministry. For these reasons the MUHC should approach the Ministry to request that they consider recognition of the LAGB procedure for such exceptional cases. In view of the fact that an effective alternative procedure exists, the TAU Committee therefore recommends that until the LAGB procedure has been approved by Qubec it should not be routinely carried out at the MUHC. It should only be carried out in exceptional circumstances, when in the opinion of the Surgeon it would carry a significantly lower risk than the LR-en-Y procedure. Even if LAGB does receive provincial approval, in view of the fact that it costs approximately 39% more than the present laparoscopic Roux-en-Y procedure, it will be necessary to demonstrate clinically meaningful superiority over a longer follow-up before it is accepted as the operation of choice at the MUHC.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.mcgill.ca/tau/publications/2004

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)