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Article: Lap-Band surgery marred by problems after 12 years


Reuters -

Lap-Band surgery marred by problems after 12 years

By Frederik Joelving

NEW YORK (Reuters Health) - An older kind of Lap-Band weight-loss surgery could lead to severe complications over the long haul, Belgian researchers said Monday.

The surgery works by 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 gnawed its way through the wall of the stomach.

"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. Jacques Himpens of the Saint Pierre University Hospital in Brussels and colleagues write in the Archives of Surgery.

"This is what I was worried about," said Dr. Mary Brandt, who heads the pediatric surgical program at Texas Children's Hospital in Houston and has criticized the Lap-Band surgery before.

"I think these data support my opinion that lap band is not the right operation for adolescents," she told Reuters Health in an email.

According to Allergan -- the Irvine, California-based company that makes the Lap-Band system -- 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.

In an email to Reuters Health, Allergan criticized the new study and said both the surgical technique and the Lap-Band itself had changed in the interim.

It also noted that the study was based on only 151 patients from a single hospital, and that the researchers had only been able to test half of those patients.

"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," Cathy Taylor, Allergan's director of Corporate Communications, said.

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.

"In some ways it is a bit of a historic snapshot of this type of surgery 15 years ago," he said. "I would take these results with a grain of salt."

On average, the patients in the study lost about 43 percent of their excess weight -- a number that was outpaced by the gold standard weight-loss surgery, called gastric bypass.

Four out of every ten patients in the study suffered a major complication of the surgery, such as the band going into the stomach or the stomach pouch enlarging. Overall, six in ten patients ended up on the operating table again.

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," Michalsky said. "It really boils down to a combination of considerations by the surgeon and the patient."

SOURCE: Archives of Surgery, March 21, 2011.


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