Re-evaluating the gastric band
- owenhaskins
- 17 hours ago
- 4 min read
Updated: 8 hours ago
Despite a decline in popularity and doubts over its long-term effectiveness, there is still a place for laparoscopic gastric banding (LAGB), according to Professor Martin Fried from the OB Klinika, Center for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. Dr Fried believes that in the right patient and with regular follow-up and compliance, LAGB is an effective weight loss option for patients who are seeking a less invasive alternative to other more complex procedures.
“There are several benefits that explain the previous popularity of LAGB. For patients, it was a less invasive option, adjustable and reversible. And, in my experience, it can be highly effective, in the right patients,” he explained. “Honestly speaking, the number of adjustable gastric band-related serious complications requiring emergency reoperations is low, and there was no major demand for long-term vitamin and mineral supplementation. So for the patient, all these things were – and still are – really very attractive, when compared to more invasive options.”
Dr Fried, who has implanted 1000s of bands, said there are two primary reasons why the band ‘fails’ – poor patient compliance and lack of follow-up. Currently, his centre implants around 50 gastric bands annually and the majority of the patients are highly motivated, attend follow-up sessions and, importantly, are compliant with the post-implant regimen.
“That is to say, most of our band patients understand that they can only eat small amounts of food at a time, they know they must chew the food sufficiently, and must avoid certain foods. It is important to educate patients so they understand the importance of compliance. The second issue is seeing patients for regular follow-up meetings. Many patients want one operation and to be ‘cured’, but that is not how the disease, that is obesity, works. It is a chronic condition and needs to be managed as one. I think in its heyday, some surgeons and many patients believed that ‘let’s get it implanted, come for a couple of adjustments, and that’s it’. But as we know, if a patient only has a couple of follow-up sessions, that’s when you get poor results and complications. We follow up all our band patients frequently, two to three times a year. Yes, it’s a considerable undertaking on behalf of the follow-up team and for the patients – time off work, travel, etc. But if follow-up is not done properly, then the band inevitably ‘fails’.”
Like all metabolic and bariatric procedures, there are pros and cons; however, the band was presented as having no advantages and all the disadvantages. This is simply untrue.”
He also said that, on reflection, when the band first came to prominence, some patients had a band but were ultimately not suitable candidates, whether for physiological, psychological or habitual (eating habits) factors. At the time, there was limited evidence on the mechanism of the band, about physiology and about the action on all the organs. Now, there is much more evidence and patients can be carefully selected and advised, as with any medical intervention.
“I do think that – as is always the way with these things – the media at first praised the band, believing it was some panacea – and then they were overly critical, stating the band was ‘bad, obsolete and does not work’. In my decades of being a metabolic and bariatric surgeon, there is never, ever, a black and white issue. Like all metabolic and bariatric procedures, there are pros and cons; however, the band was presented as having no advantages and all the disadvantages. This is simply untrue.”
He noted that when the band was at its most popular and enthusiasm about its effectiveness rose, patients were regularly attending follow-up visits, and the results were good; the data from that period clearly demonstrate its effectiveness. However, as its popularity waned, the frequency of follow-ups and the quality diminished. In addition, at the time, there was a real focus on the metabolic impact of bariatric surgery, so the interest shifted from bands to bypass and sleeve, as they were more effective procedures.
“At the moment, I know of no procedure that is a one-off. In metabolic and bariatric surgery, all the procedures necessitate some kind of follow-up. That not only means patients visit the surgeon, but from time to time, a nutritional specialist, a psychologist, a physiotherapist, etc. Obesity is truly a multifactorial disease – many factors that come together and cause the disease of obesity, so we need to treat each element. To treat a multifactorial disease requires a multidisciplinary (MDT) solution.
“It would be naive to think that the band is going to come back in the magnitude that was used 20 years ago – it has competition from endoscopic procedures, innovative technologies like magnetic anastomosis or some other lower invasive procedures are a big challenge for the band. And of course, GLP-1s.” he concluded. “On the other hand, I think that there is still a place for the band, especially in combination with the pharmacotherapy. I think pharmacotherapy could aid weight loss, lower patients’ appetites, their feeling of hunger, etc. For patients who are reluctant to have more invasive anatomy changing surgery, but who understand the need for compliance, the band remains a viable option for weight loss.”
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