Fabrizio Vinzens et al have recently published a study titled “Long-term outcome of laparoscopic adjustable gastric banding (LAGB): Results of a Swiss single-center study of 405 patients with up to 18 years follow-up”. The follow up rate was 85%. Follow up duration ranged from 8 to 18 years after Lap Band placement with one hundred patients exceeding 15 years in follow up. During this long-term follow-up 71% of adjustable gastric bands were removed. Most these patients were converted to sleeve gastrectomy, Roux-en-Y gastric bypass or duodenal switch. 29% this patient cohort still has their band in place and half of them report good to excellent outcome. Overall, 15% of the total patient population has benefited from Lap band surgery.
In my opinion, this is the best published long-term study on adjustable gastric band surgery outcome. The authors have clearly and objectively demonstrated, over an impressive mean follow up of 13 years, that lap band surgery is not an effective and durable weight loss procedure. Most importantly, the study reinforces the now established concept of metabolic surgery: mechanical restriction by itself, a naïve assumption adopted by many bariatric surgery pioneers, is not an effective weight loss solution. Yet, the FDA continues to approve weight loss procedures like gastric balloon. Other innovators in the field, are still experimenting with various endoscopic techniques of gastric volume reduction like endoscopic gastroplasty. A few bariatric surgeons still perform gastric pouch and stoma reduction procedures for gastric bypass patients. Sadly, numerous publications of successful outcomes of such non-sense procedures continue to be published in SOARD and other bariatric journals. There was a devoted session at Obesity week this year in New Orleans about new techniques in bariatric surgery. All techniques centered around gastric volume reduction and all outcomes were described as excellent and promising. Lap band surgery results in the smallest possible gastric pouch and yet it has failed to achieve any durable weight loss for most obese patients. I think this study has clearly demonstrated the futility of restrictive weight loss procedures.
It is time we learn our lessons and move forward with a new vision based on facts and a clearer understanding of metabolic surgery. Research and funds in the fields of energy metabolism, nutrition and obesity must be streamlined and centered on one important concept: Stomach volume reduction resulting in calorie reduction and starvation is not an effective weight loss solution. Once we accept this established concept, we can focus our efforts at understanding bariatric surgery mechanism of action. This will allow us to develop new less invasive and more effective solutions. It may help us develop drugs for obesity treatment. Most importantly, knowledge and evidence based medicine will allow us to test a novel weight loss procedure prior to its approval and widespread application. For instance, if increased gastric emptying is a mechanism of action of a weight loss surgery then endoscopic sleeve gastroplasty that delays gastric emptying cannot be approved for weight loss. Many patients will be spared the disappointment and frustration of a failed bariatric procedure like the current study has shown with Lap band surgery.