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Laparoscopic adjustable band: Is it a good long-term solution for all?

Laparoscopic adjustable band: Is it a good long-term solution for all?. David Urbach MD University of Toronto CABPS 1 st Annual Conference Mississauga, ON June 9, 2012. Overview. Trends in the rate of LAGB Short term outcomes Effectiveness Long term follow up. Surg Obes Rel Dis 2009.

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Laparoscopic adjustable band: Is it a good long-term solution for all?

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  1. Laparoscopic adjustable band: Is it a good long-term solution for all? David Urbach MD University of Toronto CABPS 1st Annual Conference Mississauga, ON June 9, 2012

  2. Overview • Trends in the rate of LAGB • Short term outcomes • Effectiveness • Long term follow up

  3. SurgObesRel Dis 2009

  4. SurgObesRel Dis 2009

  5. Ann Surg 2011

  6. Ann Surg 2011

  7. Overview • Trends in the rate of LAGB • Short term outcomes • Effectiveness • Long term follow up

  8. Review of published reports • (1994-2006) • Health web sites • French • English • Australian JACS 2008

  9. Ann Surg 2011

  10. Overview • Trends in the rate of LAGB • Short term outcomes • Effectiveness • Long term follow up

  11. Ann Surg 2011

  12. Diabetes mellitus Hypertension Ann Surg 2011

  13. Overview • Trends in the rate of LAGB • Short term outcomes • Effectiveness • Long term follow up

  14. 12 year follow up of 151 patients with Lap-Band 1994-1997 • 82 patients evaluated • 60% had one or more reoperation • 17% converted to RYGB • Overall EWL 43% (intent to treat) • 60% were satisfied Arch Surg 2011

  15. Arch Surg 2011

  16. Failure rate at 10 years: >50% Spivak H. SurgEndosc 2012

  17. Lin VW et al. Sur ObesRel Dis 2012

  18. Additional operation at 4+ years: 25.0% No adjustments in past year (ideal=6-8 in first year): ~40% Lin VW et al. Sur ObesRel Dis 2012

  19. Swedish Obesity Subjects Study. Sjostrom L. NEJM 2007

  20. Angelchik Prosthesis • Silicone ring placed around the lower esophagus to treat GERD • Popularized in late 1970’s/early 1980’s • Abandoned in 1990 • Most were removed • Dysphagia, erosion, obstruction

  21. Gastric bands removed in Ontario, 2011, by month (n=122) Source: Ontario Health Insurance Plan

  22. Laparoscopic adjustable band: Is it a good long-term solution for all? • Not “long-term” • Approx. 50% device survival at 10 years • Not “for all” • Severe obesity • Medical comorbidities • Cosmetic procedure for patients without morbid obesity?

  23. Laparoscopic adjustable band: Is it a good long-term solution for all? David Urbach MD University of Toronto CABPS 1st Annual Conference Mississauga, ON June 9, 2012

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