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Recent Study Sheds Unwarranted Implications on Gastric Banding

A recent study published by Himpens et al in the Archives of Surgery has been widely discussed, and terribly misinterpreted.  The study involved 82 patients who received an adjustable gastric band in Brussels, Belgium between 1994 and1997.  Over 13 years, no patients died from the band surgery; however, 9 patients (11%) suffered pouch dilation/band slip, and 23 patients (28%) suffered band erosion.  The authors concluded that, “The high failure rate of Laparoscopic Adjustable Gastric Banding, at least in our hands, could be detrimental to its future continued widespread use as a restrictive weight loss operation.”

Before getting overly excited about this report, let’s first consider these four important points:  this data conflicts with the preponderance of current evidence, the technology of the gastric bands used in this study is now considered outdated, hiatal hernias were not routinely repaired, and we have proven that this technique for band placement leads to higher rates of failure.

Current studies describe band erosion rates from 0.5% to 9%, with many near 1%.  Similar studies report pouch dilation/band slip rates from 1% to 5.6%, with many less than 4%.

The authors used the 9.75-cm adjustable gastric band (Lap-Band; BioEnterics Corp, Carpinteria, California), which has a high-pressure/low-volume balloon.  Current bands use a low-pressure/high-volume balloon, thought to potentially result in fewer complications.

Failure to identify and repair a hiatal hernia will often lead to improper placement of the band (too far down on the stomach).  This, in turn, may lead to severe symptoms of heartburn, or even pouch dilation/band slip.

The authors placed the bands by the perigastric technique.  We have learned that the pars flaccida technique (see image) significantly reduces band erosion and slippage.

If you have any further questions about this article or others, please do not hesitate to ask!