Gastric band surgery for low BMI patients

He said that the long-term results from LABG had been achieved without any significant technological innovation of the device in the last 20 years

"Low BMI patients are a target population that as metabolic surgeons we need to take care of to prevent future morbid obese patients"

Thursday, September 15, 2016 - 09:21

Owen Haskins - Editor in chief, Bariatric News

At the recent European Obesity Summit in Gothenburg, Sweden, Apollo Endosurgery hosted a symposium, which included presentations on revisional surgery, long-term outcomes, low BMI patients, band complications and the banded bypass.

Luigi Angrisani

Patients who have a BMI30.0-34.0 (class 1) and who are suffering from a significant obesity-related health burden should be offered bariatric surgery, according to Luigi Angrisani, S Giovanni Bosco Hospital, Naples, Italy. In his presentation, ‘Low BMI patients: a target population to take care of to prevent future morbid obese patients, he cited a 2014 a Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) (Obesity Surgery. Bariatric Surgery in Class I Obesity – A Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014), which states:“A clinical decision should be based on a more comprehensive evaluation of the patient’s current global health and on a more reliable prediction of future morbidity and mortality.” 

Angrisani added that such a decision should take into account “more than just a patient’s BMI.”

He said that there an array of intragastric balloons (eg.Heliosphere Bag, Reshape Dual-balloon, Orbera, Spatz Adjustable Balloon System) and endoluminal procedures (eg. Apollo Overstitch, POSE and Endobarrier) that have shown weight loss in the short-term however, these devices/procedures have not yet proved long-term efficacy.

In comparison, the LAGB procedure has demonstrated long-term efficacy. Angrisani explained that in his own centre, between January 1996 and December 2015 they have carried out 107 bariatric procedures on obese patients with BMI≤35, and 32 patients received a LAGB. The ten year outcomes from these patients revealed on average patients lost 14kgs and the BMI was reduced from 33.78 to 29.6, with 40.2 average %EWL. Moreover, only three patients (9.3%) had their band removed.

He said that the long-term results from LABG had been achieved without any significant technological innovation of the device in the last 20 years (design,  profile, material) or with little evolution of our knowledge in the last 15 years, such as the ability to calculate the ‘neo-pylorus’ diameter at time of band adjustment.

“Despite this lack of knowledge, the LAGB still remains an effective procedure and has demonstrated a high efficacy in low BMI and adolescents patients,” he concluded. “The LAGB has several advantages compared to more invasive procedures such as the absence of mortality and malnutrition, with no need for vitamin supplementation. Low BMI patients are a target population that as metabolic surgeons we need to take care of to prevent future morbid obese patients.”

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