Long-term complications requiring reoperations after laparoscopic adjustable gastric banding: a systematic review

At present, bariatric surgery is the most effective option for morbidly obese patients. Among all of the surgical procedures, laparoscopic adjustable gastric banding (LAGB) is characterized by superior safety, a stable weight loss effect, and unique reversibility. However, the worldwide popularity of LAGB is challenged and overshadowed by a number of adverse events. This systematic review examined the incidence and outcomes of the long-term complications that require reoperations after LAGB. A PubMed search was conducted through October 31, 2014, for relevant studies that included minimal 10-year follow-up data for LAGB patients. The defined outcomes of interest were weight loss outcomes, long-term complications, and reoperations. Seventeen studies, including 2 randomized controlled trials and 15 observational studies, were identified involving a total of 9706 LAGB patients, of which 8215 patients (84.6%) were followed up and 1974 patients (20.3%) were available 10 years after LAGB. The follow-up data indicated that the mean percentage of excess weight loss at 10 years after LAGB was 49.1%±13.1% and the median long-term complication rate and reoperation rate for the LAGB patients were 42.7% (5.9%-52.9%) and 36.5% (7.2%-66.1%), respectively. At the end of long-term follow-up, approximately 22.9% (5.4%-54.0%) of the LAGB patients had their bands removed and the commonest reason was complications. In conclusion, long-term adverse events are important and remarkable for LAGB patients. The role of LAGB in bariatric surgery is worthy of further appraisal, by comparing with other types of bariatric procedures, because of the limited high-quality evidence.