Gastric bands for obesity may help people lose weight, but patients frequently experience problems with the device years after they've had the procedure, a new study finds.
Nearly 40 percent of patients in the study had some type of major complication with their band 12 or more years after they had the surgery. Major complications include things like infection or erosion of the band. About half the patients had to have the band taken out, and 60 percent required additional surgery.
The findings suggest gastric bands are not the answer to the obesity epidemic, the researchers say.
"Hopefully … people realize that the band is not the key to the problem of obesity , it's not the solution," said study researcher Dr. Jacques Himpens, of the European School of Laparoscopic Surgery in Belgium. While Himpens says that the procedure can still be performed, researchers should look for more efficient, less invasive alternatives, he said.
"It's pretty sobering what they've described in their study," said Dr. Thomas Inge, a pediatric surgeon at Cincinnati Children's Hospital Medical Center. The findings are pretty consistent with those of early studies that show the band has a lot of problems in the long term, Inge said. "Every year, you accumulate more risk of complications," he said.
Others argue that the results, while concerning, may not be applicable to patients in the United States today.
"Obviously anything that shows that 50 percent of patients down the road might have a serious problem is very concerning," said Dr. Sunil Bhoyrul, a bariatric surgeon at Scripps Memorial Hospital in La Jolla, Calif. But "I'm not sure the paper is relevant to a 21st century American practice," Bhoyrul said.
The technique, as well as the product used in the study, are both outdated, he said. And the way the data was collected makes it subject to bias.
Bhoyrul advises that patients "work with surgeons who do a lot of these operations," or more than 125 a year. Doctors who don't do a lot of these procedures may not use the most modern surgical techniques and may not follow up their patients as much as is needed.
Gastric banding
The study involved 151 patients who underwent laparoscopic adjustable gastric banding between Jan. 1, 1994, and Dec. 31, 1997, at the team's obesity center in Brussels, Belgium. This procedure involves placing a silicone band around the top part of the stomach to restrict the amount of food it can hold. Studies have shown gastric banding is safer than gastric bypass surgery, meaning fewer things go wrong during the operation.
At the end of 2009, the researchers were able to follow up with 82 patients.
Twenty-two percent of patients experienced minor complications, or technical problems that can usually be treated without requiring the patient to stay in the hospital. Thirty-nine percent of patients experienced major complications, including 28 percent who experienced band erosion. Nearly 50 percent of patients lost their band within nine years. Most who had their band removed did not get another one put back in, Himpens said.
Despite these frequent complications, the majority of patients were satisfied with their procedure — only 20 percent said they were dissatisfied. Those who still had their band in place lost 48 percent of their excess weight.
Surgeons who do perform the procedure have to persuade their patients to come back frequently for follow up, Himpens said — every three months within the first year and every six months after that. In the United States, doctors typically see patients 10 times in the first year, and four to five times in the second year, said Dr. Emma Patterson, a bariatric surgeon at Oregon Health & Science University.
Different techniques
"The band certainly should not be discredited because it's the safest weight-loss surgery," Patterson said. Patterson is a consultant for Allergan Inc., a pharmaceutical company that makes gastric bands. She notes other studies have found more favorable results for gastric banding.
In addition, "the way they did the operation was an old-fashioned way, a way in which we know doesn't work," Bhoyrul said. Patterson agrees that the findings are not generalizable to modern patients.
"This does not reflect what's happening today," she said.
Himpens acknowledges that the technique used to perform the surgery is not widely used anymore, but there are some physicians who still perform it. Even with the new surgery, "unfortunately, I don't think the outcome is that much better," Himpens told MyHealthNewsDaily. But he adds the erosion rate would be lower with newer bands.
"It's very hard not to be studying history," when you do these types of studies, Inge said. Though whether differences in technique are enough to override all of the problems patients saw in this study is a question that remains to be answered.
Inge would like to see studies showing the long-term outcomes for patients in the United States. The researchers of such a study, funded by the National Institutes of Health, are being eagerly awaited, he said.
The study was published online today (March 21) in the Archives of Surgery.
Pass it on: Patients who receive gastric bands may frequently experience complications, though newer techniques and products may be less subject to these problems.
Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner.
