Better Short-term Weight Loss for Patients with Group Therapy after Gastric Banding

Digestive and Bariatric Surgery Division, Taipei Medical University Hospital, Taipei,TaiwanWeu Wang M.D.

Background:
Adjustable gastric band surgery is one of the standard surgeries for the treatment ofmorbid obesity. The results between, however, varies. Post-operative intensively
follow-up and group therapy may offer the patients better concept of eating behavior
and life style change, and further lead to better weight loss.

Materials and Methods;
From January 2008 to Dec 2009, 156 patients had received gastric banding surgery. Amongthese, 31 patients joined the post-operative group therapy including nutritionalcounseling, aerobic exercise and diet education willingly. Another 31 patients was
selected without post-operative group therapy as comparative group. The data wascollected retrospectively.

Results;
The mean BMI was 43.6+5.3 kg/m2 in the study group and 42.8+6.5 kg/m2 in comparison.
The BMI at one year after surgery was 32.8+3.6 kg/m2 and 34.2 + 4.6 kg/m2 respectively.
The average adjustment was 5.2 times in study group comparing to 3.8 times. The study
group has better loss of body fat and higher percentage of muscle component.

Conclusion:
Post-operative group therapy is effective for better weight loss and greater improvementof body fat percentage for patients undergo gastric banding.

Laparoscopic adjustable gastric banding in a Japanese instituteDepartment of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
Masayuki Ohta, MD, Teijiro Hirashita, MD, Yukio Iwashita, MD, Tadashi Ogawa, MD, Kazuhiro
Yada, MD, Takashi Masuda, MD, Hidetoshi Eguchi, MD, Seigo Kitano, MDBackground/Aim: Although bariatric surgery has not been popular in Japan, the most popularbariatric procedure is now laparoscopic sleeve gastrectomy. In 2005, we introduced
laparoscopic adjustable gastric banding (LAGB) into Japan, and here, our data werepresented and evaluated.
Methods: Between August 2005 and December 2010, 31 morbidly obese patients (18 women /13 men, mean age of 39yr) received LAGB in our institute. All patients were morbidly obese(BMI>35 kg/m2), and the averaged weight was 118 kg and BMI was 43 kg/m2. In regard to LAGB
devices, LAP-BAND® (Allergan Medical) was used in 29 patients and SAGB® (OBTECH MedicalGmbH) in 2 patients. All procedures of LAGB were performed through the pars flaccida pathway
with band fixation using gastric-to-gastric sutures. Averaged follow-up duration was 35months.
Results: All the procedures were completed laparoscopically. Two complications wereexperienced (postoperative bleeding and port trouble), and reoperations were needed inthe patients. Weight loss and % excess weight loss on the average were 25kg and 44% after
1 year, 33 kg and 57% after 3 years and 29 kg and 51% after 5 years. Accordingly,comorbidities were frequently improved, and type 2 diabetes and metabolic syndrome wereresolved in 9 of 10 patients (90%) and in 14 of 17 patients (82%), respectively.
Conclusions: LAGB is safe and effective in Japanese patients with morbid obesity, and ourdata seem to be equivalent to those previously reported in Western countries.

Patient Selection for Laparoscopic Adjustable Gastric Banding
Centre for Obesity Management and Surgery, National University Hospital, Singapore
Asim Shabbir, Litang Chen, Raymond Lim, Jia-yan Wee, Lifeng Zheng, Davide Lomanto,
Jimmy BY So.
Surgery is the most effective treatment for morbid obesity. Various bariatric
operations are available but the ideal operation remains unknown. Laparoscopic
Adjustable Gastric Banding (LAGB) is one of commonest bariatric operations. It issimple, adjustable, reversible and minimally invasive. However, the outcome of weightloss is highly variable and band-related complications occasionally occur. To achieve
the best outcomes, careful patient selection and a committed follow-up program areessential. Our centre started LAGB since 2004. In 2007 and 2008, we introduced
laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LRYGB) respectively. We
reviewed our patients who underwent bariatric surgery in the past 6 years, andcompared the results among these 3 procedures. We investigated potential predictors ofoutcomes after LAGB and we also reviewed published date for additional predictors.
Till 2010, we had 72 patients who underwent bariatric surgery (42 LAGB, 22 LSG, 8LRYGB). The median age was 44(range: 24-68) and the BMI was 41 (range: 30-57). Medianfollow-up among the three procedures was 45, 8 and 6 months respectively. The medianexcess weight loss (EWL) was 29, 34, 44% respectively. Among patients who underwent
LAGB, 29 patients (69%) defaulted follow-up in long-term. Twenty-two (52%) patients
had unsatisfactory weight loss (<30%EWL) and 6 (14%) patients developed band
complications and required band removal. In general, predictive factors for pooroutcomes include age, unwilling to change lifestyle habits and loss of follow-up. In
conclusion, long-term results of LAGB are unsatisfactory in unselected patients.
Careful patient selection is essential in achieving good outcomes in LAGB.

Lap banding in Thailand
Institute: Bunrungrad International Hospital, Bangkok
Professor Paisal Pongchairerks
Laparoscopic Gastric Banding was the first bariatric procedure done in Thailand in2003. Its preference decreased gradually as Thai surgeons acquired more expertisein other more difficult procedures. The popularity of laparoscopic sleeve
gastrectomy also seemed to contribute to this trend. However, banding still
entertained the benefit of being a relatively easy procedure among all. Surgeons
seemed to come across more long-term complication after more years of follow-up,including esophageal dilatation, reflux with or without esophagitis, slippage andband erosion. Some cases of reoperation were experienced. Nowadays, Thai surgeons
have different opinions as for the indication of gastric banding.

Gastric Band in India
Bombay Hospital Fortis Hospitals, Mumbai, India
Ramen Gyanendra Goel
Bariatric surgery started late in India. VBG was introduced in late 1990s. First gastric band
surgery in India was done in 2000 & subsequently till 2005 almost all surgeons started
bariatric career with gastric band. Most of experienced laparoscopic surgeons could adept
gastric band comfortably & numbers of band surgeries increased rapidly till realization
started settling in that band is not effective in almost 25% - 35% with 3 year explantation
rates of 20% - 30% in different hands.
Introduction of gastric bypass & sleeve gastrectomy has led to further decline in gastricband surgery’s fortunes in India. Gastric band now accounts for less than 1% of proceduresin most of bariatric practices. Few recent centers have shown renewed interest in gastricband implantations with successful outcomes.
Various reasons attributed to poor results seen by Indian surgeons may be attributed to poor
follow up due to failure to get regular adjustments due to long distances, incompletelydeveloped bariatric program, high rate of oesophageal dilatation etc. Lack of patience, due
to slow weight loss results, compared to other bariatric surgeries may also attribute to highexplanation rate.
Gastric band surgery accounts for almost 50% of bariatric procedures in USA, but only longterm follow up will show whether fate of bands will follow the Indian graph. As gastricsleeve is becoming the procedure of choice amongst bariatric surgeons & patients in India,
the future of gastric band surgery in India is bleak.