Authors' objectives: The aim of this study was to determine whether laparoscopic adjustable gastric banding (LAGB) is a safe and effective procedure compared with open and/or laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical banded gastroplasty (LVBG), especially in the longer term (> or = five years), for adult patients with clinically severe obesity.

Authors' results and conclusions: Three Health Technology Assessment (HTA) reports and 18 published primary studies, including one randomized controlled trial (RCT) comparing LAGB with LVBG, three non-randomized studies comparing LAGB with LRYGB, and 14 case series, met the inclusion criteria. These studies of variable methodological quality included adult patients with preoperative body mass index (BMI) ranging from 27 kg/m2 to 87 kg/m2. The follow-up periods available for comparison were up to three years in the RCT and up to two years in the comparative studies. Patients included in the 14 large case series (>500 patients) were followed for a period of longer than five years; however the numbers of patients available at five-year follow-up were small compared with the total number included in the entire case series. Results from the RCT and two single-centre comparative studies suggested significantly shorter operating time and length of postoperative hospital stay associated with LAGB compared with LVBG or LRYGB. Based on the RCT and three comparative studies, short-term mortality rates following LAGB were similar to those of LVBG or LRYGB with lower early postoperative complication rates. However, significantly higher long-term postoperative complications and associated re-operations following LAGB have caused safety concerns about the use of LAGB for patients with severe obesity. Furthermore, although the length of hospital stay was shorter with LAGB, management of late complications, including re-operation, may result in an increased number of hospital days in the long run. The RCT and three non-randomized comparative studies demonstrated that LAGB appeared to be effective in producing significant weight loss in patients with severe obesity. However, when compared with LRYGB, LAGB appeared to be less effective, with mean percent excess weight loss (%EWL) less than 50% at up to two years follow-up for patients with a wide range of preoperative BMIs (27 kg/m2 to 81 kg/m2). LAGB also appeared to be less effective than LVBG, with mean %EWL less than 50% at three years of follow-up for patients with preoperative BMIs between 40 kg/m2 to 50 kg/m2. Based only on the two large case series with follow-up rates available for each year, weight loss after LAGB gradually increased with careful band adjustment and achieved 47% to 54% EWL over one to five years after surgery, with 190 and 32 patients, respectively, attending five-year follow-up visit. The improvement in co-morbidities and quality of life (QOL) was reported inconsistently. LAGB resulted in improvement of certain co-morbidities (such as diabetes and hypertension) and QOL. LRYGB appeared to yield more profound improvement of co-morbidities. Patients treated with RYGB tended to report higher scores on QOL measures than did patients who received LAGB or VBG. Nutritional deficiencies following bariatric surgery, particularly a concern with RYGB (open or laparoscopic), were not reported in most studies.

Authors' recommendations: Although the intent of this report was to look at long-term (greater than five years) safety and efficacy of LAGB, it is not possible at this stage to make definitive conclusions because of weak evidence (case series), with results available for a very small number of patients. The greatest needs at present are long-term studies with systematic surveillance and minimal loss to follow-up that can better define the long-term weight loss and improvement in co-morbidities and QOL, as well as complications, following LAGB compared with LRYGB and LVBG. Future research needs to further classify patients according to their preoperative BMIs and perform subgroup analyses of results for each class of obesity according to the WHO/Canada body weight classifications. The main issue is to identify which patient group is most appropriate for which bariatric procedure. Based on the current research evidence, guidelines, and position statements, all bariatric surgeries are effective in the treatment of morbid obesity but differ in the degree of weight loss and range of complications. The current evidence base supports the current practice (RYGB or VBG) for treating clinically severe obese patients in Alberta. There is an opportunity to establish a registry that collects data on appropriate patient characteristics and links these data to meaningful outcome measures to answer the important clinical questions that the current research has failed to address.

Authors' methods: Review

Project Status: Completed

Year Published: 2005

URL for published report: http://www.ihe.ca/advanced-search/laparoscopic-adjustable-gastric-banding-for-clinically-severe-morbid-obesity-in-adults-an-update

URL for additional information: http://www.health.alberta.ca/initiatives/health-evidence-reviews-list.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>