Overweight Surgery Makes Gains

Surgery for obesity has been around now for a number of years. It’s progressed from quite invasive operations that remove or isolate parts of the stomach and joining it to an intestinal loop, to the fashionable ‘keyhole’ approach made today. Keyhole, or laparoscopic surgery, involves making one or more 1” (or less) openings in the abdominal wall, with the insertion of a telescope through one and long instruments through another. Skilled surgeons can complete complicated procedures in this way. Removal of the gall bladder by laparoscopy is now absolutely routine.

‘Gastric banding’ involves placing an adjustable band around the stomach, so that the patient feels full after eating a small amount. The band can be adjusted by inflating the amount of saline the inner layer contains, according to individual patient needs. The whole procedure can be done by laparoscopy, with only a day or so in hospital.

Gastric banding has been reserved for the ‘seriously obese’ – those with a body mass index (BMI) over 35. Now an Australian study has been reported on 80 patients with BMIs between 30 and 35 i.e. mild to moderately obese persons. Half of them had Lap-Band® adjustable banding, and the others had an intense 6-month very-low-calorie (500 to 550 calories a day) diet, plus orlistat, and counseling about exercise.

Both surgical and non-surgical groups had identical weight loss for the first 6 months, amounting to an average of 14% of their initial body weight. The surgical group continued to lose weight for the balance of the 24 months, while the non-surgical group showed progressive weight gain. After 24 months, the gastric banding patients had lost an average of 21.6% of their initial body weight, while the non-surgical patients had lost 5.5%. Clearly, laparoscopic surgery with adjustable gastric banding was superior to the non-surgical program.

This means that people with less-than-severe obesity will be asking their doctors about gastric banding surgery. It’s probably better to wait a bit, until we know more about possible rare but serious effects of the surgery; there will certainly be more published about this, soon.