Original article Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls Luca Busetto, M.D. a, *, Dario Mirabelli, M.D. b , Maria Letizia Petroni, M.D. c , Marco Mazza, M.D. a , Franco Favretti, M.D. a , Gianni Segato, M.D. a , Monica Chiusolo, M.D. b , Franco Merletti, M.D. b , Franco Balzola, M.D. c , Giuliano Enzi, M.D. a a Servizio Terapia Medica e Chirurgica dell’Obesità, University of Padova, Padova, Italy b Epidemiologia dei Tumori, University of Torino and CeRMS CPO-Piemonte, Piemonte, Italy c Istituto Auxologico Italiano, Piancavallo, Italy Received March 26, 2007; revised June 4, 2007; accepted June 21, 2007 Abstract Background: To compare the mortality rate of obese patients treated by laparoscopic gastric banding (LAGB) with the mortality rate of matched obese patients observed at medical centers. The net effect of bariatric surgery on total mortality is still controversial. Gastric bypass has been shown to reduce the relative risk of death, but similar data with LABG are still lacking. Methods: The surgical series was composed of 821 patients with a body mass index (BMI) 40 kg/m 2 consecutively treated with LAGB at Padova University, Italy. The reference group was composed of 821 gender-, age-, and BMI-matched patients selected from a sample of 4681 adults with a BMI 40 kg/m 2 observed at 6 Italian medical centers not using surgical therapy. Results: The mean follow-up was 5.6  1.9 and 7.2  1.2 years in the surgical and reference group, respectively. The vital status was known in 97.6% of the surgical group (8 deaths) and in 97.4% of the reference group (36 deaths). In the surgical group, the percentage of excess weight loss was 39.8%  17.9% 1 year after LAGB and 37.2%  23.8% 5 years after LAGB. The rate of late revisional surgery was 12.2%. Survival was estimated using the Kaplan-Meier method, and the differences between the 2 groups were evaluated using the log-rank test. The survival rate was significantly greater in the surgical group (P = 0.0004). On multivariate Cox analysis, the 5-year relative risk of death in the surgical group, adjusted for gender, age, and baseline BMI, was 0.36 (95% confidence interval 0.16 – 0.80). Conclusion: LAGB was associated with a 0% operative mortality rate and 40% stable excess weight loss. LAGB patients had a 5-year 60% lower risk of death than comparable morbidly obese patients. (Surg Obes Relat Dis 2007;3:496 –502.) © 2007 American Society for Metabolic and Bariatric Surgery. All rights reserved. Keywords: Morbid obesity; Mortality; Gastric banding The prevalence of morbid obesity is increasing world- wide at a pace that is even more accelerated than for obesity overall. In the United States [1], 3.1% of adult men and 6.3% of adult women suffer from extreme obesity as defined by a body mass index (BMI) 40 kg/m 2 , with a 400% increase in prevalence during the past 15 years [2]. It is well known that morbid obesity is associated with significant excess mortality risk. Very recently, Adams et al. [3] con- firmed in 60,000 retired Americans that morbidly obese patients had an adjusted relative risk of death 2–3 times greater than the normal weight population. Presented at the Plenary Session of the 24th Annual Meeting of the American Society for Bariatric Surgery, San Diego, California, June 11– 16, 2007. *Reprint requests: Luca Busetto, M.D., Clinica Medica I, Policlinico Universitario, Via Giustiniani 2, Padova 35128 Italy. E-mail: luca.busetto@unipd.it Surgery for Obesity and Related Diseases 3 (2007) 496 –502 1550-7289/07/$ – see front matter © 2007 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2007.06.003