Thursday, April 14, 2011

More Bariatric Follies

There's a paper out in Archives from March that pretty much slams the door on the idea of laparoscopic adjustable gastric banding (LAGB) becoming a universally accepted treatment option for morbid obesity. 151 patients were contacted over ten years after having had LAGB for follow up. Only 60% were overall satisfied with the long term results. Alarmingly, nearly 50% required surgical removal of the bands due to erosion. Long term reoperation rates were over 60%. That's bad medicine, baby.

And then I read an article like this one in the Journal of Pediatric Surgery, that tries to defend/justify the practice of slapping a choker on a teenager's stomach. Here's from the abstract:
One hundred patients aged 14 to 19 years underwent LAGB. Preoperative average weight was 136.7 kg, and median body mass index was 48.7. Comorbid medical conditions were common. Five reoperations were performed for port site bleeding, hiatal hernia repair, possible intestinal obstruction, and port slippage. Eighty-seven patients were followed for a minimum of 6 months. Average weight loss at 6 months was 12.4 (range, 33.2 to 16.2) kg, and average change in body mass index was 4.4 (range, 11.8 to −5.6).
Beyond the fact that their results are mediocre (12 kg weight loss over 6 months), I'm more concerned about the moral implications of the report---that somewhere in this country there are pediatric surgeons at major academic centers sitting down with parents and their 14 year old child, trying to convince them that they ought to consent to implanting a device that has known poor results. I mean, 14 years old. It's ghastly, really.


Anonymous said...

I tend to agree, overall. However, the reported weight loss is 12 kilos so approximately 27 pounds in 6 months or 4.5 lbs/month. This is still no more impressive than what can be achieved by lifestyle intervention in a morbidly obese person...

Jeffrey Parks MD FACS said...

anon thxs. adjustment made.