Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures

a systematic review of the randomised controlled trials

P D Chakravarty, E McLaughlin, D Whittaker, E Byrne, E Cowan, K Xu, D M Bruce, J A Ford

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background
Bariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures.

Method
Systematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay.

Results
Five RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications.

Conclusion
Co-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.
Original languageEnglish
Pages (from-to)172-182
Number of pages11
JournalThe Surgeon
Volume10
Issue number3
DOIs
Publication statusPublished - Jun 2012

Fingerprint

Bariatrics
Stomach
Randomized Controlled Trials
Weight Loss
Length of Stay
Morbidity
Quality of Life
Operative Time
Gastroplasty
Weights and Measures
Gastric Bypass
Gastrectomy
MEDLINE
Obesity

Keywords

  • adult
  • body mass index
  • female
  • gastric bypass
  • gastroplasty
  • humans
  • jejunoileal bypass
  • laparoscopy
  • middle aged
  • obesity, morbid
  • postoperative complications
  • prognosis
  • quality of life
  • randomized controlled trials as topic
  • risk assessment
  • treatment outcome
  • weight loss

Cite this

Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures : a systematic review of the randomised controlled trials. / Chakravarty, P D; McLaughlin, E; Whittaker, D; Byrne, E; Cowan, E; Xu, K; Bruce, D M; Ford, J A.

In: The Surgeon, Vol. 10, No. 3, 06.2012, p. 172-182.

Research output: Contribution to journalArticle

Chakravarty, P D ; McLaughlin, E ; Whittaker, D ; Byrne, E ; Cowan, E ; Xu, K ; Bruce, D M ; Ford, J A. / Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures : a systematic review of the randomised controlled trials. In: The Surgeon. 2012 ; Vol. 10, No. 3. pp. 172-182.
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abstract = "BackgroundBariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3{\%} of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures.MethodSystematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay.ResultsFive RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications.ConclusionCo-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.",
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AU - McLaughlin, E

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AU - Byrne, E

AU - Cowan, E

AU - Xu, K

AU - Bruce, D M

AU - Ford, J A

N1 - Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

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N2 - BackgroundBariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures.MethodSystematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay.ResultsFive RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications.ConclusionCo-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.

AB - BackgroundBariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures.MethodSystematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay.ResultsFive RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications.ConclusionCo-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.

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KW - middle aged

KW - obesity, morbid

KW - postoperative complications

KW - prognosis

KW - quality of life

KW - randomized controlled trials as topic

KW - risk assessment

KW - treatment outcome

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JO - The Surgeon

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