Control of obesity-related comorbid conditions deteriorated similarly over time.
"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.
Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.
The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.
Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.
Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.
The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m2, and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.
Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.
When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.
A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.
Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.
On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts.
Primary source: American Society of Metabolic and Bariatric Surgery
Aarts E et al. "Disappointing results in the long run after gastric banding." ASMBS 10. Abstract PL-118.