Laparoscopic adjustable gastric banding: Lessons from the first 500 patients in a single institution

Background: Laparoscopic adjustable gastric banding (LAGB) has been adopted by many bariatric surgeons. It remains under scrutiny, although it represents a major innovation in the treatment of morbid obesity. We present the lessons from the first 500 patients treated in our institution. Methods: From April 1995 to November 1998, 500 patients (421 females, 79 males) underwent an LAGB in our institution: 432 were morbidly obese and 68 were superobese. Mean body mass index (BMI) was 43, and mean excess weight was 51 kg. Results: There have been no deaths. There was one case of gastric perforation reoperated on and three cases of pulmonary and/or abdominal collections treated by drains. Two rings were changed for leakage. One ring was removed for a postoperative sigmoiditis. Three late gastric erosions occurred, requiring removal of the ring. Five access- ports have been removed for infection. 25 cases (5%) of pouch dilatation have been observed of which 18 (3.6%) led to reoperation. Mean follow-up was 21 months. Mean excess weight loss was 56% at 1 year, 65% at 2 years, and 64% at 3 years. Conclusion: This favorable outcome led us to propose laparoscopic banding to ail our patients instead of stapling gastroplasty. Short-term data should be confirmed by a longer follow-up, but indicate that LAGB should provide good results in terms of weight toss and that there are a limited number of failures. We believe that it should not be regarded just as a first-step procedure but as a final therapy, even for superobese patients.