A new study has raised troubling questions about the long-term safety and effectiveness of a popular weight-loss operation known as gastric banding that helps curb appetite by restricting the size of the stomach.
A majority of patients in the study experienced complications from the procedure, according to the findings published in Archives of Surgery. Furthermore, about half the patients required removal of their gastric bands and nearly 60 per cent needed additional operations.
The full name of the procedure is laparoscopic adjustable gastric banding. Using minimally invasive surgery, an inflatable silicone band is placed around the top portion of the stomach. When the device is inflated, or tightened, it limits the amount of food that can be held in the upper part of the stomach, making patients feel full faster.
It is meant for morbidly obese individuals who have been unable to lose weight by other means.
The operation is usually carried out at private cosmetic surgery clinics and the cost is not covered by provincial health insurance plans. Patients are charged about $16,000 for the procedure, counselling and ongoing care.
The key selling features of gastric banding are that it’s both reversible and less invasive than another operation known as Roux-en-Y gastric bypass surgery. For a gastric bypass, considered the gold standard of weight-loss operations, the size of the stomach is altered with surgical staples to create a smaller pouch for food, and the connection to the small intestine is changed. Gastric bypass is covered by provincial health plans.
Researchers at Saint-Pierre University Hospital in Brussels tracked down 82 patients who had undergone a gastric band procedure at their institution between 1994 and 1997.
The follow-up assessment revealed that 39 per cent of the patients had experienced major complications and 22 per cent had minor problems. Complications included infections, band slippage and band erosion that caused it to gradually cut into the stomach. A total of 14 patients eventually decided to undergo gastric bypass surgery.
Despite these shortcomings, 60 per cent said they were satisfied with the procedure. “Obese people are desperate and are happy with the fact they tried to do something about their weight,” lead researcher Jacques Himpens said. He noted that those who had their band still in place lost 48 per cent of their excess weight.
David Urbach, a surgeon at the University Health Network in Toronto, said this research is extremely important because few studies have looked at the long-term consequences of gastric banding.
“Patients really should be aware of the potentially significant safety problems before having a procedure like this,” said Dr. Urbach.
He also noted that there is no real advantage in the reversibility of the procedure. “Unless you do a permanent alteration you will not cure someone of their obesity,” he said. “Even if they lose 200 pounds, if they go back to the situation as it was before, all that weight is going to come back.”