Patient Selection

Optimal patient selection for laparoscopic adjustable gastric banding enables the maximizing of results for those most suited to the procedure and avoidance of unsatisfactory outcomes for those who are inappropriate. We have investigated potential predictors of outcomes in our patients to look for associations with weight loss.

We have also reviewed published data for additional predictors ajs-selecting-patient.pdf. This analysis has revealed a number of conditions associated with a significantly lower percent excess weight loss (%EWL) than experienced in the overall group. These include increasing age, increasing body mass index (BMI), hyperinsulinemia, insulin resistance, type 2 diabetes, and polycystic ovary syndrome. There was also less weight loss if the SF-36 Quality of Life measure showed poor physical activity score, high pain score, or poor general health score. However, in all these conditions, the effect was small in comparison to the benefits achieved by these patients and was judged insufficient to preclude this approach to treatment of their obesity.

A number of conditions were found to have no relationship to weight loss after LAP-BAND placement. These included gender, presence of mental illness, most comorbidities except those linked to insulin resistance, previous bariatric surgery, and sweet-eating behaviour. The only positive predictor was alcohol intake with improved weight loss occurring in those who had a modest alcohol intake compared to those who had none. The value of psychological assessment to predict outcomes could not be established.

The superobese (BMI >50 kg/m2) achieved lower %EWL at 1 year after LAP-BAND placement compared with those with BMI <50, but there were no differences at 2-, 3-, and 4-year follow-up.