A study comparing lap-band patients to RNY gastric patients was recently reported in the news media because the conclusion the authors (Campos et al) was that the rates of complications were similar between the surgeries, outcomes were better with the gastric bypass. This came out shortly after the FDA approved the LAP-BAND for lower BMI patients based on a study by the Low BMI Group.
Careful reading of the data reveals deficiencies in the RNY groups reporting mechanisms. Comparing the two studies shows that having a LAP-BAND is not only safe, but is best done in high volume centers.
Average operating room time for the LAP-BAND was 145 minutes. Contrast that with the Low BMI group average operating room time of 41 minutes. The Low BMI surgeons were highly experienced in performing the procedure and this is reflected in the operating room time. The Campos group – having over 100 minutes longer concludes that they are not a high volume center. This conclusion is supported that it took Campos over three years to enroll enough patients.
No surgery is free from complications – but the complication rate from the Campos study is higher than normal (re operation rate of 13%). Contrast that with the Low BMI study surgeons that had a re-operation rate of 4.7%. Again, the Low BMI surgeons were substantially more experienced.
Campos reported a 36% excess weight loss at one year for the LAP BAND and 64% for the RNY. This is in contrast to the Low BMI Study who had 64.5% at the first year (which is equal to what Campos reported for the RNY gastric bypass). Two-year data was not available in Campos, but the Low BMI study showed excess weight loss of 70.4%.
Follow up visits
The Lap-band works by appetite suppression. If there is no suppression of appetite the patient will not lose weight. This requires patients with the procedure to undergo periodic adjustments, particularly in the first year. The Campos protocol was to give two to three adjustments to the device in the year. The published standard is clear – that patients who have the deivce need an average of six adjustments, not three. The Low BMI study did an average of 6.2 adjustments in the first year – which no doubt accounts for the superior weight loss.
Quality of Life
The Campos Quality of Life indicators were not statistically significant. However, Quality of Life indicators for those receiving LAP-BAND surgery fare substantially higher.
The Lap-Band is not a simple operation, nor is the aftercare simple. However, high volume practices provide superior results with fewer complications than low volume centers. Conclusions about the efficacy of the device should not be made based on small of surgical studies that do low volumes. The procedure done in high volume centers provides superior outcomes in terms of less operating room time, fewer re operations, fewer complications, more adjustments, and more weight loss.
Campos, Rabl, et. Al. Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding. Arch Surg. Feb 2011
Terry Simpson, MD FACS – is a bariatric surgeon in Phoenix Arizona, and a member of the Low BMI Study Group