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 Laparoscopic adjustable gastric banding: efficacy and consequences over a 13-year period. Laparoscopic Adjustable Gastric Banding versus Open Vertical Banded Gastroplasty: A Prospective Randomized Trial A prospective study comparing vertical banded gastroplasty versus laparoscopic adjustable gastric banding in the treatment of morbid and super-obesity. The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones 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 Gastrointestinal Quality of Life Following Laparoscopic Adjustable Gastric Banding in Asia Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Long-term outcome of laparoscopic adjustable gastric banding (LAGB): results of a Swiss single-center study of 405 patients with up to 18 years' follow-up. Erosions After Laparoscopic Adjustable Gastric Banding: Diagnosis and Management Long-Term Results of a Prospective Study on Laparoscopic Adjustable Gastric Banding for Morbid Obesity Randomized Clinical Trial of Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for the Management of Patients with BMI < 50 kg/m2 Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. The Impact of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Intestinal Microbiota Differs from that of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Obesity
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 Laparoscopic adjustable gastric b and ing ( LAGB ) is a common bariatric surgery . Although it is a safe and effective method of weight reduction in short term , it may result in some problems in long term . The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients . METHODS In this prospect i ve study , 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006 . Long-term postoperative consequences and complications of these patients were recorded . RESULTS The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2 ) , respectively . Over the 13-year follow-up period , 56 patients ( 84.8 % ) experienced at least one complication . The most common complications were b and erosion ( 20 patients ) and weight regains ( 13 patients ) . Fifty-one patients ( 78.5 % ) required reoperation . The b and of 48 patients ( 72.7 % ) was removed ; of these , twenty patients ( 30.3 % ) underwent other bariatric surgeries . Percent of excess weight loss was 47.1 % ± 30.1 % , and the success rate was 48.7 % . CONCLUSIONS LAGB is a successful method with low complications in short term ; however , over long term , it results in various complications 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 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 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 : 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 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 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 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 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 BACKGROUND In the past , laparoscopic adjustable gastric b and ing ( LAGB ) seemed to be a promising bariatric procedure . However , many studies showed high rates of reoperation due to complications or insufficient weight loss . There is a lack of long-term studies with follow-up beyond 15 years . OBJECTIVE To conduct long-term follow-up of patients after LAGB and analyze their weight loss as a primary endpoint . SETTING Tertiary referral center for bariatric surgery , St. Claraspital , Switzerl and . METHODS A retrospective analysis of prospect ively collected clinical data in a cohort of 405 patients having undergone LAGB  was performed . RESULTS A total of 405 patients ( age 41±10 years , body mass index [ BMI ] 44.3±6 kg/m2 ) were treated with LAGB between 1996 and 2010 . Mean follow-up was 13±3 years , with a follow-up rate of 85 % ( range 8 - 18 years ) , corresponding to 343 patients . One hundred patients exceeded 15-year follow-up . In 216 patients ( 63 % ) , sleeve gastrectomy , gastric bypass , or biliopancreatic diversion with duodenal switch was performed as revisional surgery . Twenty-seven patients ( 8 % ) refused revisional surgery after b and removal . Finally , 100 patients ( 29 % ) still have the b and in place , with a mean BMI of 35±7 kg/m2 , corresponding to an excess BMI loss of 48±27 % . Among these , the failure rate was 25 % , according to the Bariatric Analysis and Reporting Outcome System ( BAROS ) ; 50 % had a good to excellent outcome . CONCLUSION More than 10 years after LAGB , 71 % of patients lost their b and s and only 15 % of the 343 followed patients with the b and in place have a good to excellent result , according to BAROS 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 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 Background Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) is currently the gold st and ard bariatric procedure for the treatment of morbid obesity . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively innovative procedure which has been increasingly applied lately as a sole bariatric procedure . A r and omized trial was conducted in a Greek population to evaluate perioperative safety and 3-years results . Methods Sixty patients with body mass index ( BMI ) ≤ 50 Kg/m2 were r and omized to LRYGB or LSG .  Patients were monitored for 3 years postoperatively and throughout the study period weight loss , in terms of percent excess weight loss ( % EWL ) , early and late complications , improvement of obesity related comorbidities and nutritional deficiencies were compared between groups . Results There was no death in either group and there was no significant difference in early ( 10 % after LRYGB and 13 % after LSG , P > 0.05 ) and late morbidity ( 10 % in each group ) . Weight loss was significantly better after LSG in the first years of the study and at 3 years % EWL reached 62 % after LRYGB and 68 % after LSG ( p = 0.13 ) . There was no significant difference in the overall improvement of comorbidities . Nutritional deficiencies occurred at the same rate in the two groups except to vitamin B12 deficiency which was more common after LRYGB ( P = 0.05 ) . Conclusion LSG and LRYGB are equally safe and effective in the amelioration of comorbidities , while LSG is associated with fewer postoperative metabolic deficiencies , without the need of supplementation . Furthermore , LSG is a promising bariatric procedure , equally effective to LRYGB at 3 years follow up on weight reduction Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a body mass index of 30 kg/m2 to 35 kg/m2 ; had identifiable problems , including an obesity-related comorbid condition ( such as hypertension , dyslipidemia , diabetes , obstructive sleep apnea , or gastroesophageal reflux disease ) , severe physical limitations , or clinical ly significant psychosocial problems associated with their obesity ; had attempted to reduce weight over at least the previous 5 years ; could underst and the options offered and the r and omization process ; and were willing to comply with the requirements of each program . Exclusion Criteria We excluded c and i date s with a history of bariatric surgery or medical problems that contraindicated treatment in either study group , such as impaired mental status , drug or alcohol addiction , or portal hypertension . In addition , we excluded participants if they had undergone an intensive , physician-supervised program that used very-low-calorie diets or pharmacotherapy or if they did not attend the 2 initial patient information visits . Assessment We provided detailed information about the problems of obesity and about the 2 study groups through at least 2 discussion periods and a patient information booklet . Initial assessment included anthropometric measures ; identification of medical , physical , or psychosocial problems ( both weight-related and other ) ; and a discussion of previous weight loss efforts . The assessment included a detailed dietary history by the trial dietitian and a review by a specialist physician to determine the presence and severity of associated medical conditions . Initial investigations included measurements of fasting blood glucose level ; serum insulin level ; and a lipid profile , including HDL cholesterol and LDL cholesterol levels . After initial assessment , we instituted a program of advice on appropriate eating patterns and exercise and followed each patient on a monthly basis for 3 months . During this time , we assessed the patients ' fulfillment of tasks , such as completion of a food diary , and overall adherence to appointments . R and omization Process We r and omly allocated eligible patients to receive a conventional , intensive , nonsurgical program or laparoscopic adjustable gastric b and ing .  A computer-derived r and om allocation sequence , without blocking or stratification , performed the r and omization . This was prepared at the trial office . The trial coordinator enrolled participants and informed them of the trial allocation . After assessment had confirmed a participant 's suitability for r and omization , the coordinator contacted the trial office by telephone for allocation . The study was not blinded . Description of Nonsurgical and Surgical Interventions Common Program We instructed and encouraged all patients to follow appropriate lifestyle behavior of good eating practice s and increased exercise and activity . We also encouraged them to exercise for at least 200 minutes per week . Nonsurgical Program This program centered on the use of behavioral modification , very-low-calorie diet , and pharmacotherapy with education and professional support on appropriate eating and exercise behavior . During the 2-year period , 3 trained physicians developed a program using all the available modalities for each individual on the basis of guidelines prepared and continually review ed by a panel of experienced bariatric physicians . The program began with an intensive 6-month period of very-low-calorie diet ( 500 to 550 kcal/d ) using 1 to 3 packets of Optifast ( Novartis , Fremont , Michigan ) daily for 12 weeks , followed by a transition phase over 4 weeks combining some very-low-calorie meals with 120 mg of orlistat before nonvery-low-calorie diet meals , and then 120 mg of orlistat before all meals until the completion of the intensive phase . This intensive 6-month program was followed by further courses of very-low-calorie diets or orlistat as tolerated , as well as continual behavioral , dietary , and exercise advice to assist the participant in maintaining weight loss over a prolonged period . Sibutramine was not approved for use in Australia during the first 12 months of the study and , therefore , was not incorporated into the medical program . The management program for each individual was design ed to reflect good clinical practice . A physician saw each patient every 2 weeks during the very-low-calorie diet program and every 4 to 6 weeks during the rest of the study . All patients were seen at least every 6 weeks . Surgical Program Two experienced surgeons performed the laparoscopic adjustable gastric b and ( LAP-B AND System ) procedure , by a st and ardized method ( 14 ) , within 1 month of r and omization . The b and was placed along the perigastric pathway in all cases ( 16 ) . The treating surgeon review ed patient progress every 4 to 6 weeks during the study period and made adjustments to the volume of saline within the b and in the office by using st and ard clinical criteria ( 17 ) . Adverse Events All patients in the study were question ed about the occurrence of adverse events at each consultation , and physicians recorded the 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 and Objectives Bariatric surgery improves metabolic diseases and alters the intestinal microbiota in animals and humans , but different procedures reportedly have different impacts on the intestinal microbiota . We developed laparoscopic sleeve gastrectomy with duodenojejunal bypass ( LSG-DJB ) as an alternative to laparoscopic Roux-en-Y gastric bypass ( LRYGB ) in addition to laparoscopic sleeve gastrectomy ( LSG ) for Japanese patients with obesity . We investigated the precise change in the intestinal microbiota induced by these procedures in the present study . Methods A prospect i ve observational study of 44 Japanese patients with obesity was conducted [ 22 patients underwent LSG , 18 underwent LSG-DJB , and 4 underwent laparoscopic adjustable gastric b and ing ( LAGB ) ] . The patients ’ clinical parameters and intestinal microbiota were investigated before and for 6 months after surgery . The microbiota was analyzed by a 16S rDNA method . Results LSG and LSG-DJB significantly improved the metabolic disorders in the patients with obesity . The proportion of the phylum Bacteroidetes and order Lactobacillales increased significantly in the LSG group , and that of the order Enterobacteriales increased significantly in the LSG-DJB group . Conclusions LSG and LSG-DJB improved obesity and type 2 diabetes in Japanese patients with obesity , but the impact of LSG-DJB on the intestinal microbiota differed from that of LSG . This difference in the impact on the intestinal environment could explain the different efficacies of LSG and LSG-DJB in terms of their ability to resolve metabolic disorders in the clinical setting
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 .