Erosions After Laparoscopic Adjustable Gastric Banding: Diagnosis and Management A Case-Controlled Matched-Pair Cohort Study of Laparoscopic Roux-en-Y Gastric Bypass and Lap-Band® Patients in a Single US Center with Three-Year Follow-up Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. Laparoscopic Adjustable Gastric Banding versus Open Vertical Banded Gastroplasty: A Prospective Randomized Trial First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass Is the Sleeve Gastrectomy Always a Better Procedure? Five-Year Results from a Retrospective Matched Case-Control Study A prospective study comparing vertical banded gastroplasty versus laparoscopic adjustable gastric banding in the treatment of morbid and super-obesity. Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Laparoscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Life at One Year Dietetic guidelines: diet in secondary prevention of cardiovascular disease. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Psychological outcomes and predictors of initial weight loss outcomes among severely obese adolescents receiving laparoscopic adjustable gastric banding. Pentraxin 3 and Platelet Activation in Obese Patients After Gastric Banding. Gastrointestinal Quality of Life Following Laparoscopic Adjustable Gastric Banding in Asia Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. Long-Term Results of a Prospective Study on Laparoscopic Adjustable Gastric Banding for Morbid Obesity
Objective : To define the changing prevalence of erosion after  Laparoscopic Adjustable Gastric B and ing ( LAGB ) , describing the range of clinical presentations , the approaches to treatment and the outcomes from these approaches over a 15-year study period . Background : A recent systematic review of the literature of erosion after LAGB identified 25 relevant studies and reported a total of 231 erosions in 15,775 patients giving an overall incidence of 1.46 % . The review highlighted a broad variation of incidence from 0.2 % to 33 % . The review was unable to identify either common presentations or an optimal pattern of management . Methods : Patients who underwent a primary LAGB operation between September 1994 and January 2010 by 2 surgeons ( P.O.B. and W.B. ) were identified in a prospect ively maintained data base . Those patients who had an erosion of their LAGB were identified . Presentation , operative details , demographics , body mass index , weight history , and perioperative problems were analyzed . Results : In total , 2986 patients were identified . All b and s placed were Lap-B and s ( Allergan , CA ) . Hundred erosions were experienced by 85 patients ( 2.85 % ) at a median time of 33 months from initial surgery to the erosion ( range : 11–170 months ) . The rate of erosion was highest when the b and was placed by the perigastric approach at 6.77 % . Since the adoption of the pars flaccida approach , the rate of erosion has dropped to 1.07 % . The majority of patients who had experienced an erosion ( 71 patients ; 83.5 % ) experienced only 1 erosion , 13 patients ( 15.3 % ) had 2 erosions , and 1 patient had 3 erosions . The most common presentation was loss of satiety . The b and has been successfully replaced in 56 patients . It has been explanted in 27 patients and 2 patients were converted to other bariatric procedures . The weight loss in patients who had a LAGB reinserted after erosion was not significantly different to the background cohort . Conclusions : Erosion of LAGB is uncommon and its clinical course is benign . It is best treated with a staged surgical approach ; initially , with removal and repair followed later by replacement . With this approach , weight loss is maintained and reerosion is uncommon Background : Open or laparoscopic Roux-en-Y gastric bypass ( RYGBP ) is the most common operation for treatment of morbid obesity in USA . The laparoscopic adjustable gastric b and ( LAGB ) has been the most common bariatric operation performed worldwide . The LapB and ® was approved for use in USA in July 2001 . Since then , several US surgeons have adopted one procedure preferentially over the other , and several have reported patient outcomes . We added the option of the LAGB to the RYGBP in our practice in July 2001 . We hypothesized that both procedures will provide similar weight loss and co-morbidity reduction if followed for a sufficient length of time . To enhance weight loss , we adopted a patient behavioral program that is easy to remember , in an attempt to ensure a reduction in caloric intake and reduce hunger regardless of the operation performed . Methods : A case-controlled matched-pair cohort study was conducted . All patients who presented to the Surgical Weight Control Center of Las Vegas between Aug 2001 and Aug 2004 for LAGB were placed into one group , and a matched-pair RYGBP cohort group was created . Patients in the RYGBP cohort were matched for age , sex , date of surgery , and BMI . All patients were evaluated on an intention to treat basis . Data were collected prospect ively and analyzed retrospectively . All patients were subjected to the same preoperative education regarding calorie reduction behaviors and diet change , and received the same postoperative counseling regarding long-term eating behavior and food choices . Results : During this period , 208 patients underwent LAGB and 600 underwent RYGBP .  Of the 208 LAGB patients , 181 had suitable open or laparoscopic RYGBP matches . The two groups were similar in terms of age , sex , BMI , and co-morbidities . There were no deaths in either group . Resolution of co-morbidities statistically favored RYGBP as did the weight loss , over the study period . Conclusion : When patients are matched with 3-year follow-up according to time of surgery , age , sex and BMI , LRYGBP provides superior weight and co-morbidity reduction and can be done without severe complications . However , the LAGB is an effective weight loss tool and not every patient wishes to have the LRYGBP HYPOTHESIS Outcome following laparoscopic adjustable gastric b and ing ( LAGB )  in super morbidly obese patients is significantly worse compared with the st and ard laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . DESIGN Prospect i ve case series . SETTING Community teaching hospital ( 490 beds ) . PATIENTS A prospect ively maintained data base identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004 . The study group included super morbidly obese patients ( body mass index > 50 [ calculated as weight in kilograms divided by the square of height in meters ] ) following LAGB and LRYGB .  INTERVENTIONS Among 106 patients with super morbid obesity , 60 ( 57 % ) and 46 ( 43 % ) underwent LAGB and LRYGB  , respectively . MAIN OUTCOME MEASURES Patient demographics , weight loss , percentage of excess weight loss , change in body mass index , early ( < 30 days ) and late ( > or = 30 days ) complications , reoperations , medical comorbidity , and patient satisfaction were studied . Analysis was performed using the t test and Pearson chi 2 analysis . RESULTS Overall median follow-up was 16.2 months ( range , 1 - 40 months ) . Preoperative factors of patient age , sex , weight , body mass index , and medical comorbidity were similar between the 2 groups . Compared with LRYGB , patients who underwent LAGB experienced a greater incidence of late complications ( P < .05 ) , reoperations ( P < .04 ) , less weight loss ( P<.001 ) , and decreased overall satisfaction ( P < .006 ) . Likewise , patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus ( P < .05 ) and sleep apnea ( P<.01 ) compared with the LAGB group . Furthermore , postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations . Our single mortality was in the LAGB group . CONCLUSIONS In super morbidly obese patients , LAGB is significantly associated with more late complications , reoperations , less weight loss , less reduction of medical comorbidity , and patient dissatisfaction compared with LRYGB . Further evaluation of LAGB in this patient population appears warranted Background Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term . The objective of this paper is to determine the long-term ( 10 years ) outcome for patients from a r and omised controlled trial ( RCT ) . Methods A RCT in 2002 compared laparoscopic adjustable gastric b and ( LAGB ) for obesity  with non-surgical therapy . Follow-up has been conducted at 10 years . Eighty patients ( BMI 30–35 ) were r and omised to a non-surgical or a surgical program .  Outcome data are available on 37 ( 92.5 % ) of the surgical patients and 27 ( 62.5 % ) of the non-surgical patients at 10 years . Results Weight change , the metabolic syndrome , quality of life , adverse events and direct costs of the surgical cohort were the main results of the study . A durable weight loss is present in the surgical group with a mean ( SD ) 10-year weight loss of 14.1 ( 7.7 ) kg ( 63.4 % EWL ) , better than the non-surgical group ( mean ( SD ) = 0.4 ( 10.5 ) kg ; p < 0.001 ) . The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups . Proximal gastric enlargements occurred in 17 ( 30 % ) of the 57 who had LAGB and removal of the b and occurred in 7 ( 12 % ) . The annual maintenance costs including additional surgery was AUD $ 765 per patient per year . Conclusions Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy . There is also a sustained reduction of the metabolic syndrome . There is a significant maintenance requirement after LAGB BACKGROUND We analyzed the health-related quality of life ( HRQOL ) and its determinants in the first year after laparoscopic adjustable gastric b and ing ( LAGB ) .  The setting was 10 Italian public and private bariatric surgery centers . METHODS Data collected in an ongoing , prospect i ve , 3-year multicenter Italian study on the changes in HRQOL after LAGB were used . HRQOL was investigated using the Medical Outcomes Study Short-Form 36 question naire . Hunger , satiety , and the self-perceived effects of LAGB  were recorded . RESULTS A total of 334 patients were enrolled . The follow-up rate was 92.2 % . The percentage of excess weight loss was 39.6 % ± 25.8 % , with very few side effects or complications . Hunger in the morning ( 0 - 10 scale ) was 4.5 ± 2.7 before surgery and 3.8 ± 2.4 after 1 year ( P < .001 ) . Satiety after a meal ( 0 - 10 scale ) was 7.1 ± 2.7 before surgery and 8.2 ± 1.9 at 1 year ( P < .001 ) . The self-perceived effect of LAGB on caloric intake ( 0 - 10 scale ) was 8.4 ± 1.9 after 1 year . The scores for the 8 Medical Outcomes Study Short-Form 36 subscales were significantly improved after surgery . The physical component summary score was 52.6 ± 11.9 at baseline and 79.1 ± 15.6 after 1 year ( P < .001 ) . The corresponding mental component summary scores were 52.2 ± 12.3 and 76.5 ± 17.2 ( P < .001 ) . Greater physical component summary improvement was independently associated with a low initial physical component summary ( P < .001 ) , high satiety ( P = .002 ) , a high percentage of excess weight loss ( P = .013 ) , and a high self-perceived effect of the LAGB ( P = .026 ) . Greater mental component summary improvement was associated with a low initial mental component summary ( P < .001 ) , high satiety ( P < .001 ) , a low frequency of heartburn ( P = .004 ) , and a high percentage of excess weight loss ( P = .012 ) . CONCLUSIONS Significant improvements in HRQOL were observed in the first year after LAGB . A poor baseline HRQOL , a high efficacy of the b and ing in eating control , and better weight loss might influence HRQOL changes BACKGROUND Our objective was to ascertain procedure-related morbidity among  laparoscopic Roux-en-Y gastric bypass ( LRYGB ) , laparoscopic sleeve gastrectomy ( LSG ) , and laparoscopic adjustable gastric b and ing ( LAGB ) patients . These are the 3 most common bariatric procedures performed worldwide . We review ed our experience since the introduction of LSG and compared the procedure-related morbidity among all 3 procedures . STUDY DESIGN We conducted a retrospective review of a prospect ively collected data base of all morbidly obese patients who underwent bariatric surgery between the years 2005 and 2011 . We identified and compared complications , mortality , readmissions , and reoperations in patients who underwent LRYGB , LAGB , and LSG .  RESULTS A total of 2,199 bariatric procedures were performed during this period of time . Of those procedures , 1,327 were  LRYGB  , 619 were LSG , and 253 were LAGB .  Perioperative mortality was not applicable for all 3 procedures . The leak rate was 0.5 % for LRYGB and 0.3 % for LSG , and was not applicable for LAGB . The average number of readmissions postoperatively was less than 2 times for all 3 procedures : LRYGB 1.96 times , LSG 1.49 times , and LAGB 1.54 times . The percentages of procedures requiring reoperations due to complications or failures were 14.6 % in the LAGB group , 6.6 % in the LRYGB group , and 1.8 % in the LSG group . CONCLUSIONS In short- and mid-term follow-up , LSG appears to have the lowest procedure-related morbidity when compared with LRYGB and LAGB Background : Laparoscopic adjustable gastric b and ing ( LAGB ) and open vertical b and ed gastroplasty ( VBG ) are treatment modalities for morbid obesity . However , few prospect i ve r and omized clinical trials ( RCT ) have been performed to compare both operations . Methods : 100 patients ( 50 per group ) were included in the study . Postoperative outcomes included hospital length of stay ( LOS ) , complications , percent excess weight loss ( % EWL ) , BMI and reduction in total comorbidities . Follow-up in all patients was 2 years . Results : LOS was significantly shorter in the LAGB group . 3 LAGB were converted to open ( 1 to gastric bypass ) . Directly after VBG , 3 patients needed relaparotomies due to leakage , of which one ( 2 % ) died . After 2 years , 100 % follow-up was achieved . BMI and % EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group ( 31.0 kg/m2 and 70.1 % vs 34.6 and 54.9 % respectively ) . Co-morbidities significantly decreased in both groups in time . 2 years after LAGB , 20 patients needed reoperation for pouch dilation/slippage ( n=12 ) , b and leakage ( n=2 ) , b and erosion ( n=2 ) and access-port problems ( n=4 ) . In the VBG group , 18 patients needed revisional surgery due to staple-line disruption ( n=15 ) , narrow outlet ( n=2 ) or insufficient weight loss ( n=1 ) . Furthermore , 8 VBG patients developed an incisional hernia . Conclusion : This RCT demonstrates that , despite the initial better weight loss in the  VBG group , based on complication rates and clinical outcome , LAGB is preferred . It had a shorter LOS and less postoperative morbidity Objective : To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy ( LSG )  as compared to the laparoscopic adjustable gastric b and ( LAGB ) , the laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and the open Roux-en-Y gastric bypass ( ORYGB ) for the treatment of obesity and obesity-related diseases . Background : LSG is a newer procedure being done with increasing frequency . However , limited data are currently available comparing LSG to the other established procedures . We present the first prospect i ve , multiinstitutional , nationwide , clinical ly rich , bariatric-specific data comparing  sleeve gastrectomy to the adjustable gastric b and , and the gastric bypass . Methods : This is the initial report analyzing data from the American College of Surgeons — Bariatric Surgery Center Network accreditation program , and its prospect i ve , longitudinal , data collection system based on st and ardized definitions and collected by trained data review ers . Univariate and multivariate analyses compare 30-day , 6-month , and 1-year outcomes including morbidity and mortality , readmissions , and reoperations as well as reduction in body mass index ( BMI ) and weight-related comorbidities . Results : One hundred nine hospitals su bmi tted data for 28,616 patients , from July , 2007 to September , 2010 . The LSG has higher risk-adjusted morbidity , readmission and reoperation/intervention rates compared to the LAGB , but lower reoperation/intervention rates compared to the LRYGB and ORYGB . There were no differences in mortality . Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB . Conclusion : LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year . As obesity is a lifelong disease , longer term comparative effectiveness data are most critical , and are yet to be determined Introduction Bariatric surgery is considered the most effective treatment for obesity . A recent worldwide survey demonstrated that Laparoscopic Sleeve Gastrectomy ( LSG ) is the most commonly performed bariatric procedure , while Laparoscopic Adjustable Gastric B and ing ( LAGB ) has been almost ab and oned . Objectives The aim of this retrospective study was to compare 5-year results of LSG and LAGB at our Institution . Material s and Methods Prospect i ve maintained data base of our Institution was review ed to find all patients who had undergone LSG between January 2009 and December 2011 . Inclusion criteria were BMI of 40–50 kg/m2 and age of 18–60 years old . Patients with Class I and II obesity , superobese subjects , and patients with previous history of bariatric surgery were excluded . Data on sex , age , pre-operative BMI , obesity-related diseases ( diabetes , hypertension , dyslipidemia ) , and early and late complications were collected . Each subject who underwent LSG was matched one-to-one with a patient that had undergone LAGB . Outcomes were analyzed at 1 , 3 , and 5 years of follow-up . Results A total number of 122 patients were included in this study , 61 in each group .  Better % EWL was observed in the LSG group at 1 , 3 , and 5 years . Both procedures induced improvements of obesity-related diseases without significant difference . In the LAGB group , ten patients underwent uneventful b and removal . In the LSG group , two patients had serious postoperative complications . Conclusion LSG achieves better % EWL than LAGB within 5 years , but comorbidities improvement is not significantly different . Severity of complication is higher after LSG . LAGB is still a good option for selected patients We present our prospect i ve comparative study on 60 patients subjected to two types of gastric restrictive procedures , i.e. Vertical B and ed Gastroplasty ( VBG ) and Laparoscopic Adjustable Gastric B and ing ( LAGB ) at King Abdul Aziz University Hospital , Jeddah , Saudi Arabia . The aim of our study was to compare weight reduction after both procedures . Thirty patients had VBG and thirty had LAGB based upon informed consents . The age , sex and preoperative weight and BMI were comparable in both groups . Excess weight loss of 87 % was achieved in the VBG group while only 50 % was noticed in the LAGB group at 6 months postoperatively Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative Background : The objective of this study was to determine the weight loss , changes in co-morbidities , medication usage and general health status at 1 year after laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : Prospect i ve data were obtained from all subjects undergoing LAGB .  These measurements included a medical history and review of systems , medications , height and weight and the SF-36 general health survey . Patients were seen for b and adjustments as needed throughout the year . At the 1-year follow-up visit , patients were weighed and interviewed about the status of their health conditions and their current medications , and the SF-36 was repeated . Results : Between November 2002 and November 2003 , 195 patients had LAGB . The majority of subjects were female ( 82.8 % ) , married ( 65.1 % ) , and white ( 94.9 % ) .  Complications occurred in 18 subjects ( 9.2 % ) . These included 3 slipped b and s ( 1.5 % ) , 4 port problems ( 2.1 % ) , 8 patients with temporary stoma occlusion ( 4.1 % ) , 1 explantation ( 0.5 % ) , and 1 mortality ( 0.5 % ) . Mean BMI decreased from 45.8 kg/m2 ( ± 7.7 ) to 32.3 kg/m2 ( ± 7.0 ) . Mean percent excess body weight lost was 45.7 % ( ± 17.1 ) during the first year . Major improvements occurred in arthritis , asthma , depression , diabetes , gastro-esophageal reflux disease , hyperlipidemia , hypertension , joint and back pain , sleep apnea and stress incontinence . Medication usage declined remarkably . Quality of life ( QoL ) by the SF-36 showed highly significant improvements . Conclusions : At 1 year after LAGB , patients had experienced significant weight loss , resolution of comorbidities , decreases in medication usage , and improvements in AIM To produce dietetic guidelines summarizing the systematic review evidence on dietary advice for secondary prevention of cardiovascular disease . METHODS The Cochrane Library , MEDLINE and EMBASE were comprehensively search ed for systematic review s on aspects of diet and heart health . Review s were included if they search ed systematic ally for r and omised controlled trials relating to diet and secondary prevention of cardiovascular disease . Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review . The quality and results of each review were discussed and summarized in a whole group meeting . The guidelines were trialled in seven dietetic departments and modified where necessary . RESULTS Providing evidence -based dietary information ( including increasing omega-3 fat plus fruit and vegetable intake ) to all people after myocardial infa rct ion will save more lives than concentrating dietary advice on those in need of weight loss or lipid lowering . The practice of prioritizing dietetic time to those with raised lipids is out of date since the advent of statin therapy . CONCLUSION There is good systematic review evidence that dietary advice to those with cardiovascular disease can reduce mortality and morbidity as well as modify risk factors .  Dietary advice that does this most effectively should be prioritized IMPORTANCE Many questions remain unanswered about the role of bariatric surgery for people with type 2 diabetes mellitus ( T2DM ) . OBJECTIVE To determine feasibility of a r and omized clinical trial ( RCT ) and compare initial outcomes of bariatric surgery and a structured weight loss program for treating T2DM in participants with grade s I and II obesity . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 3-arm RCT at a single center including 69 participants aged 25 to 55 years with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 30 to 40 and T2DM . INTERVENTIONS Roux-en-Y gastric bypass ( RYGB ) , laparoscopic adjustable gastric b and ing ( LAGB ) , and an intensive lifestyle weight loss intervention ( LWLI ) . MAIN OUTCOMES AND MEASURES Primary outcomes in the intention-to-treat cohort were feasibility and effectiveness measured by weight loss and improvements in glycemic control . RESULTS Of 667 potential participants who underwent screening , 69 ( 10.3 % ) were r and omized . Among the r and omized participants , 30 ( 43 % ) had grade I obesity , and 56 ( 81 % ) were women . Mean ( SD ) age was 47.3 ( 6.4 ) years and hemoglobin A1c level , 7.9 % ( 2.0 % ) . After r and omization , 7 participants ( 10 % ) refused to undergo their allocated intervention ( 3 RYGB , 1 LAGB , and 3 LWLI ) , and 1 RYGB participant was excluded for current smoking . Twenty participants underwent RYGB ; 21 , LAGB ; and 20 , LWLI , with 12-month retention rates of 90 % , 86 % , and 70 % , respectively . In the intention-to-treat cohort with multiple imputation for missing data , RYGB participants had the greatest mean weight loss from baseline ( 27.0 % ; 95 % CI , 30.8 - 23.3 ) compared with LAGB ( 17.3 % ; 95 % CI , 21.1 - 13.5 ) and LWLI ( 10.2 % ; 95 % CI , 14.8 - 5.61 ) ( P < .001 ) . Partial and complete remission of T2DM were 50 % and 17 % , respectively , in the RYGB group and 27 % and 23 % , respectively , in the LAGB group ( P < .001 and P = .047 between groups for partial and complete remission ) , with no remission in the LWLI group . Significant reductions in use of antidiabetics occurred in both surgical groups . No deaths were noted . The 3 serious adverse events included 1 ulcer treated medically in the RYGB group and 2 rehospitalizations for dehydration in the LAGB group . CONCLUSIONS AND RELEVANCE This study highlights several potential challenges to successful completion of a larger RCT for treatment of T2DM and obesity in patients with a body mass index of 30 to 40 , including the difficulties associated with recruiting and r and omizing patients to surgical vs nonsurgical interventions . Preliminary results show that RYGB was the most effective treatment , followed by LAGB for weight loss and T2DM outcomes at 1 year . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01047735 Background We hypothesized that  laparoscopic adjustable gastric b and ing ( LAGB )  reduces weight and modulates ghrelin production , but largely spares gastrointestinal endocrine function . To examine this hypothesis , we determined plasma concentrations of appetite-control , insulinotropic , and digestive hormones in relation to LAGB . Methods Twenty-four patients undergoing LAGB were prospect ively enrolled .  Body mass index ( BMI ) was measured and blood sample s obtained at baseline and 6 and 12 months post-surgery . Plasma concentrations of leptin , acylated and total ghrelin , pancreatic polypeptide ( PP ) , insulin , glucose-dependent insulinotropic peptide ( GIP ) , active glucagon-like peptide-1 ( GLP-1 ) , gastrin , and pepsinogens I and II were measured using enzyme-linked immunoassays . Results Median percent excess weight loss ( % EWL ) over 12 months was 45.7 % with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery ( p < 0.001 ) . Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery ( p < 0.001 ) . In contrast , plasma levels of acylated and total ghrelin , PP , insulin , GIP , GLP-1 , gastrin , and pepsinogen I did not change in relation to surgery ( p > 0.05 ) . Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months . Conclusions LAGB yielded substantial % EWL and a proportional decrease in plasma leptin . Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss . Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term BACKGROUND For over a decade , the laparoscopic adjustable gastric b and ( LAGB ) was 1 of the most performed bariatric procedures in Europe . This study is a retrospective analysis with prospect ively collected data of the experience in 1 specialized Dutch center with the adjustable gastric b and over 14 years . METHODS Between 1995 and 2003 , 201 patients underwent an LAGB for morbid obesity in our hospital . Data on preoperative clinical characteristic , postoperative outcome and weight loss patterns , and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System ( BAROS ) . RESULTS Average follow-up was 13.6 ( ± 2.0 ) years ( 163 mo ) and 99 % of patients with complete follow-up . Two thirds of patients reached an excess weight loss (EWL)>50 % at some point after LAGB placement . However , due to insufficient weight loss or complications in 53 % of patients , the LAGB had to be removed or converted to a Roux-en-Y gastric bypass . Additionally , half of the remaining patients had disappointing results according to the BAROS score . In total , less than one quarter ( 22 % ) of patients had a functioning b and with a good result after the follow-up period . Although initially the number of patients experiencing co-morbidities was reduced , most of them returned and a large number of patients developed new co-morbidities . Complications , other than weight regain , were numerous as 47 % of patients experienced at least 1 . In total , 204 reoperations were performed in 137 ( 68 % ) patients . Furthermore , patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up . CONCLUSION Morbid obesity is a chronic disease that can be resolved with bariatric surgery . One of the treatment options is the LAGB , which in the short term shows good results in terms of EWL and co-morbidity reduction . In the long term , however , EWL and co-morbidity reduction are disappointing , and the LAGB does not seem to live up to expectations . Besides the decrease in EWL over time , the number of reoperations required is alarming . In total , less than a quarter of patients still had a functioning b and after a mean 14 years of follow-up OBJECTIVE Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery . The role of mental health providers in this population is not well defined , and the selection of c and i date s is often the result of clinical judgment alone . The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric b and ing ( LAGB )  by ( 1 ) examining changes in depressive symptoms and quality of life in the year following surgery ; ( 2 ) evaluating the interaction between patterns of change in depression , quality of life , and weight postsurgery ; and ( 3 ) identifying presurgical psychological predictors of initial weight change . METHOD Participants were 101 severely obese adolescents aged 14 to 18 years receiving LAGB at the Center for Adolescent Bariatric Surgery at the Morgan Stanley Children 's Hospital of New York Presbyterian/Columbia University Medical Center between August 2006 and December 2009 . Measures of height , weight , depressive symptoms , and quality of life were obtained in the first year following surgery . Changes in the Beck Depression Inventory ( BDI ) , Pediatric Quality of Life Inventory ( PedsQL ) , and body mass index were analyzed using latent growth curve modeling . RESULTS Short-term changes in psychiatric symptoms and weight were analyzed using latent growth curve modeling . Significant changes in total BDI ( βslope = -0.885 , SE = 0.279 , P < .01 ; βquadratic = 0.054 , SE = 0.021 , P < .001 ) and PedsQL ( βslope = -0.885 , SE = 0.279 , P < .001 ) scores were observed following LAGB , and comparable postoperative changes between psychosocial variables and body mass index were also noted ( BDI : covariance [ COV ] = 0.21 , SE = 0.06 , P < .001 ; PedsQL : COV = -0.41 , SE = 0.10 , P < .01 ) . Two variables ( family conflict/loss of control eating ) were found to be significant predictors of weight change over the year following surgery ( P < .05 ) . CONCLUSIONS Adolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB , and measures of preoperative binge eating and family conflict affected postsurgery body mass index among youth . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01045499 BACKGROUND Circulating pentraxin 3 ( PTX3 ) , the main regulator of the inflammatory response , rapidly increases following cardiovascular events , and low PTX3 is associated with high body mass index . METHODS AND RESULTS We conducted a 12-month longitudinal study , to test the hypothesis that laparoscopic adjustable gastric b and ing (LAGB)-induced weight loss was associated with changes in platelet activation markers and PTX3 . Twelve obese patients , scheduled to undergo LAGB , were enrolled at the University Obesity Center . Urinary 11-dehydro-thromboxane (Tx)B2excretion rate was measured on radioimmunoassay , and PTX3 and CD40L were determined on immunoassay .  Plasma PTX3  increased by 178.8 and 214.9 % ( P<0.0001 ) , respectively , 6 and 12 months after LAGB . High-sensitivity CRP decreased by 24 and 29.7 % ( P<0.0001 ) , whereas CD40L decreased by 64.3 and 58.6 % ( P=0.002 ) , respectively . Urinary 11-dehydro-TxB2decreased from 1,443 to 715 and 564 pg/mg creatinine , respectively 6 months and 12 months after LAGB ( P<0.0001 ) . PTX3 was inversely related to platelet activation markers , 11-dehydro-TxB2 and CD40L . Moreover , multiple regression analysis on pooled data showed that plasma PTX3 was an independent predictor of urinary 11-dehydro-TxB2 . CONCLUSIONS There is an association between inflammation , platelet activation and metabolic dysfunction in obesity , and PTX3 is a key player within these circuits Background : Laparoscopic adjustable gastric b and ing ( LAGB ) is a safe and effective treatment for morbid obesity . Previous studies in Western countries disclosed a significant improvement in co-morbidities and health-related quality of life . Data from Asia and regarding the specific GI quality of life following LAGB are lacking . Methods : From May 2002 to May 2005 , 107 consecutive patients – 48 men and 59 women , with mean age 31.4 years ( range 17 - 57 years ) with morbid obesity ( mean weight 115.8 kg , range 81 - 174 kg ; mean BMI 41.3 kg/m2 , range 32.0 - 59.8 kg/m2 ) underwent LAGB in a prospect i ve trial . All b and s were placed via the pars flaccida technique .  Quality of life was measured by the Gastrointestinal Quality of Life Index ( GIQLI ) , a 36item question naire before LAGB , and at 3 , 6 , 12 and 24 months after surgery . Results : All procedures were performed laparoscopically with no conversions . There was neither intra-operative complications nor major postoperative complications . Minor complications occurred in 3 patients ( 2.8 % ) ; all were transient stoma obstruction . At follow-up , only one b and ( 0.94 % ) was removed at 3 months postoperatively because of the patient 's intolerance . No gastric slippage occurred . 4 patients ( 3.7 % ) had tubing problems and required revision surgery for port adjustment . Mean BMI decreased from 41.3 to 33.1 after 2 years . Percent excess BMI loss averaged 48.1 % at 2 years ( range 6.7 - 139.2 ) . All co-morbidities were eliminated significantly . 80 % of patients were satisfied with the results at 2 years . However , the GIQLI score remained similar before and after surgery . Preoperative score was 110.8 + 15 points . The score became 116.2 + 13 , 114.7 + 13 , 108.5 + 14 and 107.2 + 17 at 3 , 6 , 12 and 24 months . The patients had improvement in 3 domains of general health ( social , physical and emotional functions ) , but decrease in the domain of symptoms . Conclusion : Although LAGB was successful in weight loss and resolution of co-morbidities in morbidly obese patients , the GIQLI did not improve . This feature will be the major disadvantage of LAGB BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric b and ing ( LAGB ) or laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . The objective of this study was to compare outcomes of patients r and omly assigned to undergo LAGB or LRYGB  at 10 years . METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 ± 8.9 years ; range 20 - 49 ) were r and omly allocated to undergo either LAGB  ( n = 27 , 5 men and 22 women ; mean age 33.3 years ; mean weight 120 kg ; mean body mass index [ BMI ] 43.4 kg/m(2 ) ) or LRYGB ( n = 24 , 4 men and 20 women ; mean age 34.7 ; mean weight 120 kg ; mean BMI 43.8 kg/m(2 ) ) . Data on complications , reoperations , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . The data were analyzed using Student 's t test and Fisher 's exact test , with P<.05 considered significant . RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients . Reoperations were required in 9 ( 40.9 % ) of 22 LAGB patients and in 6 ( 28.6 % ) of the 21 LRYGB patients . At 10-year follow-up , the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients ( 69±29 % versus 46±27 % ; P = .03 ) . CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results ( 76.2 % versus 46.2 % ) at 10 years . However , LRYGB exposes patients to higher early complication rates than LAGB ( 8.3 % versus 0 % ) and potentially lethal long-term surgical complications ( internal hernia and bowel obstruction rate : 4.7 % ) AIM To evaluate the cost-effectiveness of laparoscopic adjustable gastric b and ing ( LAGB ) versus st and ard medical management ( SMM ) in obese patients with type 2 diabetes from a UK healthcare payer perspective . METHODS A vali date d computer model of diabetes was used to project outcomes reported from a r and omized clinical trial of LAGB versus SMM in obese patients with type 2 diabetes . Two-year follow-up data from the trial were projected over a 40-year time horizon and cost-effectiveness was assessed from the perspective of the National Health Service . Future costs and clinical outcomes were discounted at 3.5 % annually and all costs were reported in 2010 pounds sterling . A series of sensitivity analyses were performed . RESULTS LAGB was associated with benefits in HbA1c , systolic blood pressure , body mass index and serum lipid concentrations , which led to significant increases in discounted life expectancy ( an increase of 0.64 years ) and quality -adjusted life expectancy ( an increase of 0.92 quality -adjusted life years , QALYs ) and reduced incidence of diabetes complications relative to SMM . Treatment costs in the LAGB arm increased by 4552 Great British Pounds ( GBP ) , but this was partially offset by cost savings result ing from a reduction in the incidence of all modelled diabetes complications . The incremental cost-effectiveness ratio of GBP 3602 per QALY in the base case fell well below commonly quoted willingness-to-pay thresholds in the UK setting . CONCLUSIONS On the basis of data from a recent r and omized controlled trial , LAGB is likely to be considered cost-effective from the healthcare payer perspective when compared with SMM of obesity in patients with type 2 diabetes in the UK setting CONTEXT It has been hypothesized that increased plasma bile acids ( BAs ) contribute to metabolic improvements after Roux-en-Y gastric bypass ( RYGB ) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones . OBJECTIVE The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis ( insulin secretion and sensitivity ) and energy metabolism ( resting energy expenditure and thyroid hormone axis ) . DESIGN , PARTICIPANTS , INTERVENTION , AND MAIN OUTCOME MEASURE : Eighteen extremely obese subjects were studied before and after 20 % weight loss , induced by either laparoscopic adjustable gastric b and ing ( LAGB ) ( n = 10 ) or RYGB surgery ( n = 8) . RESULTS Plasma BAs more than doubled after RYGB [ fasting : 1.08 ( 0.26 - 1.42 ) to 2.28 ( 1.59 - 3.28 ) μmol/L , P = .03 ; postpr and ial : 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L , P = .01 ] but were either lower or did not change after LAGB [ fasting : 1.80 ( 1.49 - 2.19 ) to 0.92 ( 0.73 - 1.15 ) μmol/L , P = .02 ; postpr and ial : 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L , P = .14 ] . Skeletal muscle expression of TGR5 targets , Kir6.2 and cyclooxygenase IV , increased after RYGB but not LAGB . Surgery-induced changes in BAs were associated with increased peak postpr and ial plasma glucagon-like peptide-1 ( r(2 ) = 0.509 , P = .001 ) and decreased serum TSH ( r(2 ) = 0.562 , P < .001 ) but did not correlate with the change in insulin response to a meal ( r(2 ) = 0.013 , P = .658 ) , insulin sensitivity ( assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure ) ( r(2 ) = 0.001 , P = .995 ) , or resting energy expenditure ( r(2 ) = 0.004 , P = .807 ) . CONCLUSIONS Compared with LAGB , RYGB increases circulating BAs and TGR5 signaling , but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism Background The objective of this study was to study the long-term outcome of adjustable gastric b and ing in the treatment of morbid obesity . In Europe , the preference for gastric b and has declined in favor of Roux-Y-gastric bypass . Methods This is a follow-up of a prospect i ve study on a large cohort of patients after laparoscopic gastric b and ing ( LAGB ) for morbid obesity . Results Complete data were collected on 656 patients ( 88 % ) from a cohort of 745 patients . After a median follow-up of 95 months ( range 60–155 ) , the mean BMI dropped from 41.0 ± 7.3 to 33.2 ± 7.1 kg/m2 , with a 46.2 ± 36.5 % excess weight loss ( EWL ) . A more than 50 % EWL was achieved in 44 % of patients . The b and was still in place in 77.1 % of patients ; conversion to gastric bypass after b and removal was carried out in 98 ( 14.9 % ) patients , while a simple removal was done in only 52 ( 7.9 % ) patients . B and removal was more likely in women and patients with a higher BMI . Conclusions After LAGB , b and removal was necessary for complications or insufficient weight loss in 24 % of patients . Nearly half of the patients achieved a more than 50 % EWL , but in 88 % , a more than 10 % EWL was observed . LAGB can achieve an acceptable weight loss in some patients , but the failure in one out of four patients does not allow proposing it as a first-line option for the treatment of obesity
Although the strength of the evidence base is limited by the small number of studies , observational study design s and method ological weaknesses , the results indicate that short-term positive changes occur post surgery , including reduced caloric intake , contributed to by reductions in fat , carbohydrate and protein intake .
There is a paucity of high- quality evidence regarding changes in dietary intake after LAGB .
BACKGROUND Laparoscopic adjustable gastric b and ing ( LAGB ) is currently one of the most popular surgical obesity treatments worldwide .
Although dietary modification is recognised as a key factor in determining weight loss and health outcomes post surgery , existing evidence regarding changes in dietary intake after LAGB has not been systematic ally evaluated .
This is essential for developing best- practice dietetic guidelines for the management of LAGB patients .
The aim of this systematic review was to evaluate the current evidence base regarding changes in dietary intake after LAGB .