Authors' objectives:

This report will update VATAP's 2004 bibliography report of quality filtered systematic reviews, meta-analyses and primary studies, focusing on evaluations of laparoscopic adjustable gastric banding as the technology of interest.

Authors' recommendations: New data on the comparative safety and efficacy of LAGB® to other bariatric surgical techniques such as gastric bypass (GBY) from primary studies and other systematic reviews confirm the findings from BCBS TEC (2007), which are repeated here:“…The current body of literature lacks high-quality clinical trials that directly compare outcomes between LAGB and GBY. Therefore, the conclusions in this Assessment are derived from other types of evidence, primarily comparisons of clinical series with or without matching.Weight loss at 1 year is less for LAGB compared with GBY, and conclusions on the comparative weight loss at longer time periods are not possible from these data. Some studies report that the difference in weight loss between these procedures diminishes, or disappears, with longer follow-up. However, the present data are mixed, and overall, do not confirm this hypothesis. It appears more likely from the current data that attrition bias may account for the diminution of the difference in weight loss over time, particularly when patients who have their band removed or deflated are excluded from analysis.The data on long-term complications remain suboptimal. The reporting of long-term complications in these trials is not systematic or consistent. As a result, highly variable rates of long-term outcomes are reported. It is not possible to determine the precise rates of long-term complications from these data, but it is likely that complications are under-reported in many studies due to incomplete follow-up and a lack of systematic surveillance. The high rates of long-term complications reported in some studies raise concern for the impact of these events on the overall benefit/risk ratio for LAGB.In comparing LAGB with GBY, there is a tradeoff in terms of risks and benefits. LAGB offers a less-invasive procedure that is associated with fewer procedural complications, a decreased hospital stay and earlier return to usual activities. However, the amount of weight loss will also be less for LAGB. The patterns of long-term complications also differ between the two procedures. For LAGB, longer-term adverse events related to the presence of a foreign body in the abdomen will occur, and will result in reoperations and removal of the band in a minority of patients. Patients who have their bands removed can later be offered an alternative bariatric surgery procedure, such as gastric bypass.For patients considering bariatric surgery, there is sufficient evidence to allow an informed choice to be made between gastric bypass and LAGB. An informed patient may reasonably choose either GBY or LAGB as the preferred procedure. Preoperative counseling should include education on the comparative risks and benefits of the two procedures in order to allow the optimal choice to be made based on patient and surgeon preferences.”In light of the growing demand for LAGB® in VA and limitations in the existing knowledge base about the comparative risks and benefits of LAGB® versus other bariatric procedures particularly in patients similar to the veteran population, there is a need to study these bariatric procedures in the veteran population and monitor outcomes systematically over the long term.

Authors' methods: Bibliography

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/SurgicalTreatmentsMorbidobesity2007ttm.pdf

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: Technology Assessment Unit, Office of Patient Care Services, US Department of Veterans Affairs (VATAP)