Prospective study of a two-stage operative concept in the treatment of morbid obesity:: Primary Lap-Band® followed if needed by sleeve gastrectomy with duodenal switch

Background: We investigated the success rate of a two-stage operative concept for treatment of morbid obesity: primary laparoscopic adjustable gastric banding (LAGB, Lap-Band (R)) for all morbidly obese patients, followed by sleeve gastrectomy with biliopancreatic diversion (duodenal switch or DS) in case of failure. Methods: From Dec 1996 to May 2004, 366 consecutive patients (female 78%, mean age 41 (17-66) years, BMI 44.3 (35-75) kg/m(2) were prospectively evaluated, using the two-stage operative concept. The follow-up rate after a mean of 4.1 (1-8.4) years was 98%. Primary outcome measure was BAROS score, defined according to weight loss, quality of life, reduction in co-morbidities, complications and re-operations. Results: A very good-to-excellent result was found in 118 patients (32%),141 (39%) had a good results, 76 (21%) a fair result, and 31 (8%) were failures. 39 patients needed re-banding due to slippage, 68 a DS, and 11 patients had band removal. Early morbidity of the Lap-Band (R) was 3.8%, that of DS 13%, and mortality was zero. The excess weight loss at last follow-up of all the patients was 44% (40% after Lap-Band (R)/rebanding, and 82% 2 years after DS). Conclusion: The two-stage concept with primary LAGB, followed by DS in case of failure, leads to a good result in 71% of morbidly obese patients. LAGB alone does not appear to be an adequate procedure for every morbidly obese patient.