Doubts raised over Lap-Band surgery in the long term: Study

By Dr. Ananya Mandal, MDMar 21 2011

According to Belgian researchers an older type of Lap-Band weight-loss surgery could lead to severe complications over the long term.

This surgery is based on the principle of placing a silicone band around the top portion of the stomach to restrict food intake. It has become an increasingly popular option in the battle against obesity, but some experts have worried about its safety.

The Belgian team found that as many as half their patients, followed for at least 12 years, needed to have the band removed in that period. And in more than a quarter, the band had bitten its way through the wall of the stomach. Among 82 patients followed for at least 12 years after lap-band surgery at a single institution, 49 had at least one reoperation for complications or device failure. 41 had the bands removed during follow-up, with 14 then undergoing Roux-en-Y gastric bypass surgery. In all but a few cases, inadequate weight loss or device breakdown was the reason for band removal.

Dr. Jacques Himpens of the Saint Pierre University Hospital in Brussels and colleagues write in the Archives of Surgery, “The high failure rate of (Lap-Band surgery), at least in our hands, could be detrimental to its future continued widespread use as a restrictive weight loss operation.” Dr. Mary Brandt, who heads the pediatric surgical program at Texas Children's Hospital in Houston and has criticized the Lap-Band surgery before and says now, “This is what I was worried about…I think these data support my opinion that lap band is not the right operation for adolescents.”

In reply to this news Allergan - the Irvine, California-based company that makes the Lap-Band system, said that its product has been used in more than 500,000 procedures worldwide. It commands more than two-thirds of a $300 million to $400 million market. The company criticized the new study and said both the surgical technique and the Lap-Band itself had changed in the interim. They said that this new study involved only 151 patients from a single hospital, and that the researchers had only been able to test half of those patients. Cathy Taylor, Allergan's director of Corporate Communications said, “We are disappointed to see the publication of an ill-constructed, single-center clinical assessment that does not meet the high clinical standards one should expect from peer-reviewed data, and is not reflective of today's clinical standards.”

Dr. Marc P. Michalsky, surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Columbus, Ohio, seconded the criticism saying, “In some ways it is a bit of a historic snapshot of this type of surgery 15 years ago…I would take these results with a grain of salt.”

In 2009, more than 220,000 Americans had some type of weight loss surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery. “I don’t think there’s one operation that is good for everybody…It really boils down to a combination of considerations by the surgeon and the patient.” Michalsky said.