Laparoscopy
Risk factors for the intermediate outcome of morbid obesity after
laparoscopically placed adjustable gastric banding
Oliver Thomusch, M.D.*, Tobias Keck, M.D., Ernst V. Dobschütz, M.D.,
Christoph Wagner, M.D., Klaus Dieter Rückauer, M.D., Ulrich Theodor Hopt, M.D.
Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Hugstetter Strasse 55, 79106 Frieburg, Germany
Manuscript received October 20, 2003; revised manuscript April 15, 2004
Abstract
Background: The overall long-term results of medical treatment for morbid obesity are poor. Surgery is the only treatment option to obtain
long-term weight reduction. Analysis of risk factors for treatment success of laparoscopically placed gastric banding (LGB) has not been
available until now.
Methods: Prospective study with 99 patients with LGB between January 1997 and July 2003. The parameters assessed as risk factors
included onset of obesity, feeling of postprandial satiety, and initial body mass index (BMI).
Results: Median follow-up was 36 months (3 to 72). Independent prognostic factors of excess body weight reduction (25%) were for the
first postoperative year: onset of obesity as an adolescent (relative risk [RR] 0.21), an initial BMI 45 kg/m
2
(RR 4.76), and a BMI between
45.1 and 50 kg/m
2
(RR 3.23). After the second year, independent prognostic factors were as follows: feeling of postprandial satiety (RR
5.26) and an initial BMI 45 kg/m
2
(RR 3.03).
Conclusion: LGB is suitable to achieve intermediate weight reduction in patients with morbid obesity. To obtain the best results, patients
should be treated before they achieve a BMI 45 kg/m
2
. Additionally a postprandial feeling of satiety after LGB is mandatory for good
long-term results. © 2005 Excerpta Medica Inc. All rights reserved.
Keywords: Gastric banding; Morbid obesity; Multivariate analysis; Prospective study; Risk factors of treatment success
Obesity is one of the most frequent chronic diseases in the
Western world and occurs with a frequency of 10% to 15%
and an ever-increasing incidence [1,2]. It causes or aggra-
vates many diseases and is associated with major physical
and psychosocial disabilities [3] and cancer [4]. Severe
obesity is not only a modern problem in the developed
world, even Avicenna (Ibn-Sina, 980 to 1037 AD), the
Persian physician and philosopher, devoted an entire chap-
ter to obesity in his Canon of Medicine [5]. The etiology of
massive obesity is complex [6–8]. Anyone treating these
patients observes that “simple overeating” is often not the
sole reason. Genetic and other biologic influences often
override environmental causes [9 –12]. Medical treatment of
obesity may be successful when dealing with moderate
obesity, but the National Institutes of Health Conference
Statement on Methods of Voluntary Weight Loss and Con-
trol stated that although $30 billon are spent in the United
States to control excess body weight, the overall results of
medical treatment for clinically severe obese patients are
poor [3]. Optimal programs of diet, exercise, drug therapy,
and behavioral modification can be expected to provide a
sustained weight reduction if therapy continues indefinitely.
Unfortunately, for most obese patients this is either insuf-
ficient or unsustainable. Since 1954, surgery has been per-
formed in an attempt to control morbid obesity [13], and the
outcome of these surgical techniques has improved steadily
during the last 20 years [14 –18]. Different investigators
have claimed that for the morbidly obese, bariatric surgery
is the most successful manner of losing weight and keeping
it off [3,19 –21]. Various surgical methods for weight con-
trol can achieve major weight reduction over a prolonged
period for a majority of patients [14,15,22,23]. Compared
with malabsorptive surgery, gastric restrictive operations
result in less weight loss [24,25] and fewer of the metabolic
and nutritional deficiencies associated with bypass proce-
dures [16]. One restrictive surgical treatment option is lapa-
* Corresponding author. Tel.: +49-761-2702401; fax: +49-761-
2702782.
E-mail address: o.thomusch@gmx.de
The American Journal of Surgery 189 (2005) 214 –218
0002-9610/05/$ – see front matter © 2005 Excerpta Medica Inc. All rights reserved.
doi:10.1016/j.amjsurg.2004.04.015