Impact of Lap-Band Size on Weight Loss: Does Gender Matter?
Tóm tắt
Laparoscopic adjustable gastric band (LAGB) has gone through major design modifications to improve clinical endpoints and reduce complications. Little is known, however, about the effects of LAGB size on clinical outcomes, or whether outcomes differ based on gender. We set out to examine the impact of band size on surgical weight loss, reoperations, comorbidity resolution, and compare outcomes within gender. We reviewed our prospectively collected longitudinal bariatric database between 2008 and 2010, and compared patients with BMI 35–50 kg/m2 who had undergone LAGB with the LAP-BAND® APS to those who had the larger APL. Those patients with initial BMI > 50 kg/m2 were excluded to reduce any possible selection bias which favors larger band use in such subjects. Three hundred ninety-four patients met our inclusion criteria; 230 (58 %) in the APS group and 164 (42 %) in the APL group. Female patients in APS group experienced significantly higher percentage excess body weight loss at 6 months, 1 year, and 2 years in comparison to female patients in APL group (p < 0.001 for all time points). In contrast, a reverse pattern was observed for male patients. No significant differences were observed between the groups regarding frequency of band adjustments, complications, or comorbidity resolution. Male patients might benefit from APL bands, in contrast to female patients who appear to experience superior weight loss with the smaller APS bands. This study provides the first set of evidence to facilitate surgical decision making for band size selection and highlights differences between genders.
Tài liệu tham khảo
Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19(12):1605–11.
LAP-BAND AP® Adjustable Gastric Banding System with OMNIFORM® Design. Directions for use. Irvine, CA: Allergan. 2009.
Chau WY, et al. Patient characteristics impacting excess weight loss following laparoscopic adjustable gastric banding. Obes Surg. 2005;15(3):346–50.
Wolnerhanssen BK, et al. Predictors of outcome in treatment of morbid obesity by laparoscopic adjustable gastric banding: results of a prospective study of 380 patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2008;4(4):500–6.
Dixon JB, Dixon ME, O’Brien PE. Pre-operative predictors of weight loss at 1-year after Lap-Band surgery. Obes Surg. 2001;11(2):200–7.
Dixon JB, O’Brien PE. Selecting the optimal patient for LAP-BAND placement. Am J Surg. 2002;184(6B):17S–20S.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.
Favretti F, O’Brien PE, Dixon JB. Patient management after LAP-BAND placement. Am J Surg. 2002;184(6B):38S–41S.
Deitel M, Greenstein R. Recommendations for reporting weight loss. Obes Surg. 2003;13(2):159–60.
Lyass S, et al. Device-related reoperations after laparoscopic adjustable gastric banding. Am Surg. 2005;71(9):738–43.
Parikh MS, Fielding GA, Ren CJ. U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc. 2005;19(12):1631–5.
Mittermair RP, Aigner F, Nehoda H. Results and complications after laparoscopic adjustable gastric banding in super-obese patients, using the Swedish band. Obes Surg. 2004;14(10):1327–30.
Angrisani L, et al. Results of the Italian multicenter study on 239 super-obese patients treated by adjustable gastric banding. Obes Surg. 2002;12(6):846–50.
Chevallier JM, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246(6):1034–9.
Ponce J, et al. New adjustable gastric bands available in the United States: a comparative study. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(1):74–9.
O’Brien PE. The LAP-BAND AP™ system: the platform advances. Bariatric Times. 2007;4(5):24–6
Dixon AF, Dixon JB, O’Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90(2):813–9.
de Jong JR, et al. Weight loss after laparoscopic adjustable gastric banding is not caused by altered gastric emptying. Obes Surg. 2009;19(3):287–92.
Burton PR, et al. Effects of adjustable gastric bands on gastric emptying, supra- and infraband transit and satiety: a randomized double-blind crossover trial using a new technique of band visualization. Obes Surg. 2010;20(12):1690–7.
Frank S, et al. Processing of food pictures: influence of hunger, gender and calorie content. Brain Res. 2010;1350:159–66.
Haase L, Green E, Murphy C. Males and females show differential brain activation to taste when hungry and sated in gustatory and reward areas. Appetite. 2011;57(2):421–34.
Chial HJ, et al. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms: effects of gender, body mass index and age in health. Neurogastroenterol Motil. 2002;14(3):249–53.
Ardestani A, Lautz DB, Tavakkolizadeh A. Band revision versus Roux-en-Y gastric bypass conversion as salvage operation after laparoscopic adjustable gastric banding. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(1):33–7.
Wolnerhanssen B, et al. Reduction in slippage with 11-cm Lap-Band and change of gastric banding technique. Obes Surg. 2005;15(7):1050–4.
Dargent J. Pouch dilatation and slippage after adjustable gastric banding: is it still an issue? Obes Surg. 2003;13(1):111–5.
Chevallier JM, et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg. 2004;14(3):407–14.
Kurian M, et al. Evaluating gastric erosion in band management: an algorithm for stratification of risk. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2010;6(4):386–9.
Matlach J, et al. Small-diameter bands lead to high complication rates in patients after laparoscopic adjustable gastric banding. Obes Surg. 2011;21(4):448–56.
Naef M, et al. Esophageal dysmotility disorders after laparoscopic gastric banding—an underestimated complication. Ann Surg. 2011;253(2):285–90.
Azagury DE, et al. Does laparoscopic gastric banding create hiatal hernias? Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011. doi:10.1016/j.soard.2011.07.015
Shen R, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9.