Laparoscopic banding safe, effective for BMI under 35.

PHILADELPHIA -- Laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/[m.sup.2] might be safe and effective for weight loss and improvement of obesity-related comorbidities, according to a review of over 50 patients.

The study is the first to evaluate the effect of laparoscopic adjustable gastric banding (LAGB) in U.S. patients with a BMI less than 35. This BMI value is the cutoff used in National Institutes of Health guidelines on patient selection criteria for weight-loss surgery in people with significant comorbidities, said Dr. Manish Parikh of the general surgery department at New York University.

Of the 53 patients in the study (mean age 47 years), 49 had at least one obesity-related comorbidity, and 44 were women.

The patients' mean preoperative BMI of 33 declined to 28 after 6 months and to 26 after 2 years. The patients lost 48% of their excess weight after 6 months and 70% after 2 years. More than 80% of the patients were available for follow-up at 2 years.

Overall, 75% of the patients had improvement or resolution of their comorbidities, Dr. Parikh reported at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

The weight loss and improvement in comorbidities seen in the study are important when put into the context of a previous study in which researchers estimated a 25% increase in mortality and 3-4 years of life lost for individuals with a BMI of 25-35 -- about 20% of U.S. adults, Dr. Parikh said (JAMA 2003;289:187-93).

Previous studies of LAGB in patients with a BMI less than 35 outside the United States have reported similar results. A study of 210 Italian patients reported 72% excess weight loss at 5 years, 89% resolution of comorbidities, an 8% complication rate, and one death 20 months postoperatively due to sepsis stemming from the perforation of a dilated gastric pouch (Obes. Surg. 2004;14:415-8).

A previous study conducted by Dr. Parikh and his associates found that 93 Australian patients lost an average of 54% of their excess weight at 3 years, with improvement or resolution of comorbidities in most (Surg. Obes. Relat. Dis. 2006;2:518-22).

The "most compelling data" for operating on these patients, according to Dr. Parikh, come from a trial in which 80 Australian patients were randomized to undergo LAGB or an intensive nonsurgical weight loss program (Ann. Intern. Med. 2006;144:625-33). The LAGB patients lost a significantly greater percentage of excess weight at 2 years than the nonsurgical group did (87% vs. 22%).

Two of Dr. Parikh's coinvestigators are on the medical advisory board for Allergan Inc., which manufactures the Lap-Band system used in the study.

BY JEFF EVANS

Senior Writer