Adjustable Gastric Band Reoperation Cost

I read with great interest this large retrospective study, titled “Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery” that was recently published in JAMA surgery. The authors analyzed the outcomes of 25 042 obese Medicare patients who underwent gastric band surgery between 2006 and 2013. They found that 20% of analyzed patients underwent gastric band related revision procedure at a staggering cost of 224 million dollars. Of note, during the study period, Medicare paid $470 million for laparoscopic gastric band–associated procedures. Reoperations included band removal, band replacement or revision to a different bariatric procedure like gastric bypass or sleeve gastrectomy. 80% of the reoperations were elective suggesting that weight loss failure or development of severe GERD rather than acute band slippage were the main cause for revision.

The study highlights the long-term complication rate of adjustable gastric banding and associated cost. The results are no surprise to the majority of bariatric surgeons in Houston, TX. Indeed, adjustable gastric band surgery is no longer performed in Houston. Band removal for weight loss failure and intractable GERD is the main band related operation we currently perform at Houston Weight Loss Surgery Center. Most band patients referred to our practice have gastric pouch and esophageal dilation as well as hiatal hernia leading to severe acid reflux disease.

Gastric band was developed based on the assumption that gastric volume reduction by itself results in durable weight loss. This erroneous assumption has been largely debunked by multiple studies showing that obesity is a hormonal disorder. Effective weight loss surgery like sleeve gastrectomy alters some of these hormones leading to durable weight loss. Surprisingly, some bariatric surgeons still advocate the use of gastric banding like Jon Gould, MD who wrote an invited commentary to this study titled “Considering the Role of the Laparoscopic Adjustable Gastric Band: Do Not Throw the Baby Out with the Bathwater”. He argues that gastric band surgery still has a role to play in bariatric surgery. According to Dr. Gould it takes a committed bariatric surgeon and equally committed patient for gastric banding to succeed. They say old habits die hard and despite the overwhelming evidence regarding obesity pathophysiology bariatric surgery mechanism of actions some surgeons still linger in the past. Neither patient will power nor bariatric surgeon commitment can reverse the complex neuro-hormonal disorder that lead to fat accumulation. These false assumptions that are still being used to push for procedures like gastric balloon and endoscopic sleeve gastropalsty no longer have a place in a twenty first century bariatric and metabolic surgery practice. So, let’s throw this baby out for good, with its bathwater, and save our patients unnecessary complications and disappointment. There is no role for gastric banding in any obese patient population. It is time for the FDA to withdraw its approval of such a device.