Age,Obesity Surgery,and Weight Loss

Some centers consider an age over 50 to be a contraindication for obesity surgery. This study was conducted to examine the relationship between age and one-year postoperative weight of patients receiving gastric restrictive surgery (n = 616) for morbid obesity. Patients were divided into four age groups (18-29, 30-39, 40-49, 50-65 years) matched for preoperative obesity. At one year there were no statistically significant differences in weight loss or postoperative obesity. There were four (0.6%) surgically related deaths. The mortality of patients aged 50 or older (1.1%) was not significantly higher than that of younger patients (0.6%). It was concluded that older age per se need not be a contraindication for surgery.     

Psychosocial Outcome and Long-Term Weight Loss after Gastric Restrictive Surgery for Morbid Obesity

Forty-five of 60 consecutive morbidly obese patients who had a vertical banded gastroplasty carried out by the one surgeon between 1982 and 1988 were assessed by questionnaire at long-term follow-up in 1993. Eighteen patients (40%) had maintained their BMI at close to the lowest achieved levels. Twenty-seven patients (60%) had had a significant rise in BMI, and 14 of these (31%) had gained weight to return close to or above their pre-surgery BMI levels. No reliable predictors of successful long-term weight loss were detected in the pre-operative data. Forty-eight patients (84%) were satisfied with their surgical treatment. Twenty patients (44%) reported improved social life after surgery. Twenty-one patients (46%) reported a similar social life and only four patients (9%) a worse social life. At follow up five patients (12%) reported emotional problems related to their weight loss surgery and two of this group had had psychiatric counselling for depression. Pre-operative psychiatric assessment appeared to have facilitated intervention by the psychiatrist with these patients. Gastric restrictive surgery, however, remains unpredictable in its long-term weight loss effect.     

Changes in Resting Energy Expenditure and Body Composition after Weight Loss following Roux-en-Y Gastric Bypass

Background The objective of this study was to evaluate changes in resting energy expenditure (REE), body composition and metabolic parameters, and to investigate predictors of the results in seriously obese patients after Roux-en-Y gastric bypass (RYGBP). Methods 31 patients (BMI 44.4 ± 4.8 kg/m2; 27 female, 4 male; 37.3 ± 11.1 y) were evaluated at baseline and 6 months after RYGBP. Weight, REE, waist circumference (WC), fat mass (FM) and fat-free mass (FFM), physical activity, food intake, fasting glucose (GLU), insulin (INS), HOMA-IR and lipid concentrations were measured. Results At 6 months, percentage of weight loss (%WL) was 29.0 ± 4.4% and percentage of excess weight loss was (%EWL) 59.7 ± 12.3%. FM loss corresponded to 77.1 ± 12.2% of the weight loss. REE decreased from 33.4 ± 4.1 to 30.1 ± 2.6 kcal/kg FFM (P < 0.05). Significant decreases (P < 0.001) were observed in GLU, INS, HOMA-IR, LDL-cholesterol and triglycerides. %EWL was correlated with baseline INS (r = 0.44; P = 0.014), baseline HOMA (r = 0.43; P = 0.017), change in %FM (r = 0.67; P < 0.001) and change in WC (r = 0.5; P < 0.01). Decrease in REE/FFM (%) was positively correlated with baseline REE/FFM% (r = 0.51; P < 0.005) and change in %FM (r = 0.69; P < 0.001). Initial REE/FFM, baseline energy balance and FM change explain 90% of REE/FFM decrease. Conclusion RYGBP was an effective procedure to induce significant weight loss, fat mass loss and improvement in metabolic parameters in the short term. Metabolic adaptation was not related to FFM wasting but to a higher baseline REE. Fasting hyperinsulinemia was the best single predictor of weight loss after RYGBP. Supported by a grant from University of Chile (DID–SAL 01/04–2).     

Long-Term Follow-up after Gastric Surgery for Morbid Obesity: Preoperative Weight Loss Improves the Long-Term Control of Morbid Obesity after Vertical Banded Gastroplasty

Background: Gastric restrictive surgery in a large non-university teaching hospital has been combined with preoperative weight loss by diet. The aims of preoperative dieting were to test patient motivation, to reduce perioperative morbidity, to accustom patients to the restriction of food intake after surgery, and to increase total weight loss. This study was performed to investigate the long-term results of this approach. Methods: 200 morbidly obese persons were operated on between 1978 and 1986 after they had lost more than 50% of their excess weight by diet. 100 Roux-en-Y gastric bypasses (RYGB) and, after 1983, 100 vertical banded gastroplasties (VBG) were performed. Data from medical records and data concerning present weight, complaints, food intolerance, nutritional deficiencies, and medical follow-up visits were obtained by questionnaire. Results: The lowest body weight was obtained 1 year after operation with an average excess weight loss (EWL) of 78% after RYGB and 75% after VBG. Body weight gradually increased, and 7 years after surgery the average EWL was 67% after RYGB and 63% after VBG. Ten patients had died (three postoperatively after RYGB). Preoperative dieting did not decrease perioperative morbidity and mortality in comparison with other reports. Conclusions: After combined preoperative dieting and VBG, weight loss is greater than after surgery alone. No additional weight loss after preoperative dieting was observed in RYGB patients. Most patients who underwent bariatric surgery still experience nutritional, physical, and cosmetic problems 7 years after surgery.     

Does Gastric Restriction Surgery Reduce the Risks of Metabolic Diseases?

Background: Certain risk factors for arteriosclerosis are associated with obesity, e.g. hypertension, insulin resistance, the high triglyceride - low HDL pattern. One aim in treating morbid obesity is to reduce these risk factors. This study was designed to follow metabolic risk factors after weight loss in 165 morbidly obese patients who underwent a gastric restriction operation. Methods and Patients: Lipid and hormone levels were analyzed before surgery and after 25, 50, 75 and 100% loss of excess weight. Mean cholesterol and triglyceride levels were normal or slightly elevated. HDL cholesterol was also normal (41 mg/dl). Thirty eight percent of the patients had elevated cholesterol and triglyceride levels. Insulin levels were measured as an indicator of potential insulin resistance, and with a mean of 21 μU/ml it was at the upper normal level. Results: After reaching 75% reduction of overweight in a mean time of 10 months, serum cholesterol levels were unchanged. Serum triglycerides, however, decreased by 35% (P < 0.0001) and HDL cholesterol increased by 24% (P < 0.0001). Insulin levels decreased to 8 μU/ml (P < 0.0001). Conclusion: We found an amelioration in the metabolic parameters in 75% of the patients. Nevertheless morbidly obese patients were found to have fewer abnormalities in lipid and glucose metabolism than expected from data of overweight patients with metabolic syndrome. Further long-term studies with careful evaluation of the metabolic parameters as risk factors in patients with morbid obesity need to be performed. ? 1998 Rapid Science Ltd.     

Outpatient Weight Loss Surgery: Initiating a Gastric Bypass and Gastric Banding Ambulatory Weight Loss Surgery Center

Background:

Ambulatory surgery or outpatient surgery is becoming increasingly common. In 2002, 63% of all operations performed in the United States were ambulatory procedures. Bariatric procedures performed in the United States have increased from 16,200 in 1992 to approximately 205,000 in 2007. In 2002, our center began offering laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures on an outpatient basis for select candidates at an ambulatory surgery center (ASC). We subsequently added laparoscopic adjustable gastric band procedures (LAGB) in 2005.

Methods:

Between 2002 and 2008, 248 LRYGB and LAGB patients were carefully selected for ASC surgery by the bariatric surgeon and medical director. Extensive preoperative education was mandatory for all surgical candidates.

Results:

Since 2002, we have performed 248 bariatric cases at the ASC, including 38 LRYGB and 210 LAGB procedures. In this overall experience, 5 patients (2%) required readmission within 30 days of surgery, and 98.6% of LAGB patients were discharged the same day; 62% were discharged after a 4-hour to 6-hour stay in the ASC. All LRYGB patients remained in the ASC overnight and were discharge within 24 hours of their procedure. Weight loss results have been excellent.

Conclusion:

LAGB surgery can be safely performed in an ASC setting in most patients. LRYGB can be performed safely in the ASC setting with careful scrutiny and cautious selection of patient candidates.     

The Influence of Dumping on Weight Loss After Gastric Restrictive Surgery for Morbid Obesity

Background: The dumping syndrome that follows Roux-en-Y gastric bypass for morbid obesity is considered to be the primary mechanism of improved weight loss as compared with the purely restrictive vertical banded gastroplasty. To evaluate the influence of dumping on post-operative weight loss, severity of dumping was determined using Sigstad's clinical diagnostic index. Methods: One hundred and thirty seven gastric bypass and 19 gastroplasty patients were assessed 18-24 months following surgery. Sigstad's criteria for the dumping syndrome were met by 75.9% of gastric bypass and no gastroplasty patients. Among gastric bypass patients, no relationships were found between severity of dumping and weight loss, as measured by per cent of excess body weight loss or change in body mass index. Weight loss was significantly greater with gastric bypass than gastroplasty patients (72.5 compared to 47.9% of excess body weight loss). All gastroplasty and 24.1% of gastric bypass patients were classified as nondumpers. The difference in weight loss between surgical procedures was not related to dumping: gastric bypass non-dumpers lost significantly more weight (69.1% excess body weight loss) than gastroplasty patients. Conclusions: This study fails to demonstrate a significant relationship between dumping severity and weight loss. It is inferred that the superior weight loss of gastric bypass compared to gastroplasty has some other etiology.     

Energy Expenditure and Weight Regain in Patients Submitted to Roux-en-Y Gastric Bypass

Background  Although Roux-en-Y gastric bypass (RYGBP) is a highly effective treatment for clinically severe obesity, not all patients achieve desirable weight loss and maintenance. There is some evidence that weight loss can induce a disproportionate reduction in resting metabolic rate (RMR). This reduction in RMR can be related to fat-free mass (FFM) loss, as FFM is the greatest responsible for variations in energy expenditure at rest. Abnormally low basal metabolic rate may predispose surgical patients to weight regain. Method  Thirty-six individuals were divided into two groups: patients who have kept a healthy weight 2 years after surgery and patients who showed weight regain of at least 2 kg 2 years after the surgery. Selected patients have signed a consent form. Body mass index and excess weight loss were evaluated. RMR and body fat percentage were measured. FFM is a heterogeneous component that can be partitioned into muscle mass and no-muscle mass. The FFM was calculated as the result of subtracting total fat weight from total body weight in kilogram. We also wanted to know if the predictive formulas to assess RMR overestimate energy expenditure in these patients. Statistical tests were used to analyze the two groups. Results  We found out that the RMR of the weight regain group was statistically inferior to the mean of the healthy weight group—the difference between the two groups was about 260 kcal/day. We also found out that the predictive formulas overestimate the RMR in the weight regain group. Conclusion  This study suggests that a lower RMR may contribute to weight regain in patients who undergo RYGBP. It is important to ensure ways to elevate energy expenditure in the patient, such as increasing the percentage of fat-free mass in the body and the practice of physical activities.     

Suboptimal Weight Loss after Gastric Bypass Surgery: Correlation of Demographics, Comorbidities, and Insurance Status with Outcomes

Although Roux-en-Y gastric bypass surgery (RYGBP) is safe and effective at achieving weight loss in the majority of severely obese patients, a subset fails to achieve expected weight loss outcomes. Factors associated with poor weight loss are not well defined. Patients undergoing open RYGBP using a standardized surgical technique and clinical pathway by a single surgeon at a dedicated bariatric center were reviewed. Suboptimal weight loss was defined as failure to lose at least 40% excess body weight by 12 months postoperatively. Of 555 consecutive patients who underwent RYGBP from 1999 to 2004, a 12-month follow-up was available for the 495 (89%). Suboptimal weight loss occurred in 55 (11%) and was associated on unadjusted bivariate analysis with increased body mass index (BMI; p = 0.0002), diabetes mellitus (p = 0.0002), Medicaid insurance (p = 0.04), and male sex (p = 0.01). On adjusted multivariate analysis, increased BMI (p = 0.003), diabetes (p = 0.002), and male gender (p = 0.04) were associated with suboptimal weight loss, but type of insurance (p = 0.11) was not. Medicaid patients were younger (p = 0.01) and had higher BMI (p = 0.0002). Suboptimal weight loss after RYGBP appears to be associated with greater BMI, male sex, and diabetes but not type of insurance. This study may help identify patients who could benefit from increased perioperative education and counseling or selection of procedures with greater malabsorption. Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington DC, May 19–24, 2007.     

Effect of Surgically Induced Weight Loss on Asthma in the Morbidly Obese

Forty morbidly obese asthmatic patients who underwent gastric restrictive surgery more than 2 years earlier were evaluated to determine the influence of weight loss on asthma outcome. Mean percentage excess weight loss in this group was 68% and body mass index (BMI) fell from a mean of 46 to 30. Following surgery, 90% showed improvement in asthma symptoms. Complete remission of asthma occurred in 48% and a further 12.5% became asthma free on reduced medications dosage. Of those taking daily medications for asthma before surgery, 42% were completely off medication following weight loss surgery, and another 18.5% experienced fewer asthma attacks on reduced medication dosage. Of the 22 patients with severe asthma (> 10 attacks per year) on routine daily medications for asthma preoperatively, 8(36%) required no medication after surgery, 7(32%) used medication only on an ‘as-needed’ basis, and 7(32%) controlled their asthma on reduced medication dosage. Five patients gained weight during the follow-up period. All developed an increased incidence of asthma attacks, which again abated after successfully losing weight following revisional surgery. Coexistent factors of smoking and clinically apparent esophageal reflux were evaluated, but no statistically significant correlation was shown with either smoking or reflux and improvement in asthma. Possible etiologies of the improvement in asthma with weight loss are discussed.     

Changes in Measured Resting Energy Expenditure after Roux-en-Y Gastric Bypass for Clinically Severe Obesity are Not Related to Bypass Limb-length

Background: Roux-en-Y gastric bypass (RYGB) for clinically severe obesity (CSO) results in a ‘paradoxical’ response of the measured resting energy expenditure (MREE) in which the MREE remains within the predicted range based upon the Harris-Benedict (HB) equation, despite a significant decrease in caloric intake to 500-1000 kcal/day. The mechanism for this response is unknown. A study was undertaken to determine whether the changes in MREE after RYGB are related to limb-length of the gastric bypass. Methods: A prospective clinical trial of varying limb-lengths based on body mass index (BMI) in patients having RYGB for CSO. The records of patients who underwent RYGB for CSO and had MREE measured at baseline, 6 months and 12 months postoperation were reviewed. MREE was performed using a Med Graphics? CCM system after an overnight fast or at least 4 hours after a light meal, and a 30 minute rest in a supine position in a neutral environment, on the same day of the week between the hours of 10a.m. and 4p.m. Patients were selected for RYGB in accordance with NIH recommendations. RYGB was performed in a standardized fashion with the Roux limb-length varied as follows: (A) BMI ≤ 51 kg/m² - 75 cm limb (n = 20); (B) BMI ≤ 51 kg/m² - 150 cm limb (n = 16); (C) BMI ≥ 51 kg/m² - 150 cm limb (n = 18); or (D) BMI ≥ 51 kg/m² - 250 cm limb (n = 6). Results: Data from 60 patients (nine male, 51 female; mean age 39 years; mean baseline BMI 51.5 ± 10 kg/m²; mean baseline weight 145 ± 32 kg) were analyzed. There were no significant differences in MREE or percentage HB-predicted energy expenditure between the groups. Conclusions: These data suggest that the observed changes in MREE following RYGB for CSO are not related to the limb-length of the bypass.     

Revisional Surgery for Severe Obesity with Fascia Banded Stoma Roux-en-Y Gastric Bypass

The fascia banded stoma Roux-en-Y gastric bypass (RYGBP) has been effective both as a primary and revision operation for severe obesity or failure of another operation. Since May 1984, 361 primary and 100 revisional fascia banded RYGBP operations have been reported. Weight loss achieved a mean body mass index of 30 for primary and 31 for revision patients at most recent follow-up of 3-6 years (mean 4.3 years) postoperatively. Mean overweight was 28% for primary, and 34% for revision patients. Eighty percent of primary and 79% of revision patients were within 50% of ideal weight. Revision rates for these patients were 0 for primary and 1% for revision patients. Operative mortality was 0 for primary and 1% for revision patients. Since morbidity and mortality, although low, are higher for revision than primary surgery, it is important to use an effective primary operation.     

Weight Loss and Food Intake 18 Months following Vertical Banded Gastroplasty or Gastric Bypass for Severe Obesity

Background: vertical banded gastroplasty (VBG) and gastric bypass Roux-en-Y (GBP) are adjunctive to lifelong commitment to energy restricted diet in the attempt by the severely obese to lose weight and maintain weight loss. Methods: the outcome of 48 subjects (36 VBG and 12 GBP) is presented. Results: 18 months nutritional counseling and follow-up indicated VBG and GBP to be equally effective in maintaining appreciable weight loss. Achievement of ‘functional weight’, such as minimum 50% loss of excess body weight for at least 12 months post-operatively occurred in the majority of patients. Excess weight loss by GBP and VBG was 77% and 54% respectively during the first 6 months, with 7-15% additional loss during the next 12 months. BMI decreased from an average 43 to 27 kg m⁻² after 12 months. During the first 3 months, energy intake was approximately 2930 kJ, increasing to ∼4605 kJ at 6 months, to ∼5860 kJ at 12 months and then stabilizing. Intake of ∼50% of the Recommended Daily Allowance (RDA) for most vitamins and minerals was reached. Haemoglobin, iron, folic acid and thiamin values were in the normal range for the entire 18 months follow-up, while serum vitamin B₁₂ levels decreased to deficiency levels during the same period. The pre-operative moderately elevated triglycerides, cholesterol, glucose and insulin levels returned to normal range, thereby alleviating the need for medication and reducing the risk of obesity-related morbidity. Most subjects were quickly satiated with small amounts of solid foods and did not report hunger feelings for the first 6 months post-operatively. The main significant changes in food preferences in the first 6 months were the decrease in starch-based products and the increase in semi-solid milk products and eggs. Conclusion: taken together these observations suggest that the subjects should be strongly advised to partake in structured counseling for an extended period of time.     

Lengthening the Roux-Y Limb Increases Weight Loss after Gastric Bypass: a preliminary report

We compared two variants of gastric bypass which have been used at our hospital since 1984. Initially all patients had a standard 45 cm Roux-Y anastomosed to a 30 cc gastric pouch. Subsequently we increased the length of the Roux-Y from 45 to 90 cm. In all patients the jejunum was divided 15-20 cm from the ligament of Treitz. There were six males, and 49 females with a mean age of 35 years. All were at least twice their ideal weights (range 91.5 to 179, X = 127.6). Percentage follow-up ranged from 100% at three months to 13% at 66 months for both the standard and lengthened Roux-Y groups. There were no major technical or metabolic complications. Doubling the length of the standard Roux-Y limb increased the percentage excess weight lost by approximately 6% without diarrhea or other apparent metabolic sequelae.     

Disappointing Weight Loss among Shift Workers after Laparoscopic Gastric Bypass Surgery

Background Shift work is an increasingly common employment structure in the United States and has been associated with increased rates of obesity and the metabolic syndrome. Shift work can necessitate altered patterns of sleep, eating, and activity over traditional work schedules. We investigated the effects of shift work on postoperative weight loss in bariatric surgery patients. Methods A retrospective chart review of 389 patients undergoing laparoscopic Roux-en-Y gastric bypass was conducted. Shift workers were identified as patients with at least 2 years of employment primarily outside the hours of 8:00 am to 5:00 pm preoperatively and without return to a traditional schedule in the period up to 1 year postoperatively. Trends in excess body weight loss were categorized and compared between the shift workers and the nonshift workers in the cohort. Student’s t-test was used for statistical analysis. Results 8 shift workers were identified in the cohort. They had an average age of 45.9 years and preoperative BMI of 54.6, as compared to an age of 43.6 and BMI of 47.0 for the non-shift-workers in the cohort. 75% were female, compared to 83% for the non-shift-workers. Average postoperative excess weight loss for the shift workers was significantly lower than in the non-shift-workers: 29.9% vs 43.8% (P < .01) at 3 months, 46.4% vs 61.3% (P < .01) at 6 months, and 56.5% vs 76.8% (P < .01) at 12 months. Conclusions The postoperative period in bariatric surgery requires significant adjustments in patients’ lives. The potential for altered sleep physiology, reduced quantity of sleep, altered hormonal balance, increased tendency to disordered eating, and poorer quality of food intake, are all possible etiologies for substandard weight loss outcomes in shift workers undergoing bariatric surgery. Additional care should be taken in preoperative counseling and postoperative management of these patients.     

Preoperative Weight Loss as a Predictor of Long-term Success Following Roux-en-Y Gastric Bypass

BACKGROUND: All patients undergoing gastric bypass surgery at this institution are recommended to achieve a goal of 10% total body weight (TBW) loss prior to surgery. The objective of this study was to determine whether preoperative TBW correlated with 3- and 4-year weight loss outcome. METHODS: This study was conducted prospectively at a large teaching hospital. All adult patients with 3- and 4-year follow-up data since the start of the study in 1998 to September 2007 were included. All data are expressed as mean +/- SD. Pairwise correlation and ordinary least squares regression analysis was used to determine the strength of association between preoperative TBW loss and weight loss at 3 and 4 years. RESULTS: One hundred fifty patients (120 females), age 45.3 +/- 8.9 years, were included. Their body mass indexes (BMIs), preoperatively and after 3 years, were 52.2 +/- 9.8 and 35.4 +/- 8.2 kg/m(2), respectively. There was a significant correlation between preoperative and 3-year TBW lost (9.5 +/- 6.8% vs 31.9 +/- 11.7%, r = 0.302, p = 0.0002) and between excess body weight (EBW) lost preoperatively and after 3 years (16.1 +/- 11.3% vs 55.1 +/- 20.2%, r = 0.225, p = 0.006). Ninety five patients had follow-up data available at 4 years. Their mean preoperative BMI was 52.6 +/- 9.7 kg/m(2) and decreased to 37.5 +/- 9.0 kg/m(2). The TBW loss prior to and after surgery (10.0 +/- 6.5% vs 29.4 +/- 11.5%) was significantly correlated (r = 0.247, p = 0.015). The EBW loss preoperatively and after 4 years correlated positively (17.1 +/- 11.1% vs 50.8 +/- 19.8%, r = 0.205, p = 0.046). CONCLUSION: There is a significant correlation between weight loss attained preoperatively and sustained weight loss at 3 and 4 years.     

Weight Loss Curve Analysis

The purpose of this study was to develop a mathematical model to describe weight loss trend over time and to determine differences, if any, among various weight loss trends. Weight change was studied following Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). The total number of patients analysed was 3172, 63.5% VBG and 36.5% RGB. Median age (years) for VBG was 36 (range 18-70) and RGB 38 (range 18-66). Median operative body mass index (BMI) (kg/m²) for VBG was 45.0 (range 30.1-90.5) and RGB 43.3 (range 30.4-80.6). Females represented 87% of the VBG patients and 89% of RGB patients. Obesity category percentages for each operative type were: super--VBG 20%, RGB 14%; morbid--VBG 78%, RGB 80%; obese--VBG 2%, RGB 6%. The development of a mathematical model to study weight loss over time was a two-stage process. First, weight loss trend was determined as evidenced by individual patient BMI values plotted over time. It was observed that plots represented quadratic curves, so the model BMI = B₀ + B₁(time) + B₂(time)² was used. Second, the estimated beta's (B₀, B₁, B₂) were treated as response variables to estimate weight loss trend for the combination effect of three independent variables: gender (male and female), obesity category (super, morbid, obese) and operative type (VBG and RGB). It was found that the three independent variables simultaneously interact with patient weight loss (p = 0.0001).     

Esophageal Anatomy and Function in Laparoscopic Gastric Restrictive Bariatric Surgery: Implications for Patient Selection

Background: The purpose of this study was to assess factors of clinical importance in morbidly obese patients having a laparoscopically adjustable gastric band (LAP-BAND?) implanted in order to achieve weight loss. Methods: Preoperative evaluation of hiatus hernia and esophageal (dys)motility were compared with the need for reoperation. Results are presented for the first 50 consecutive patients entered. Results: Nine of the first 50 patients required reoperation (18%). Five (10%) were for LAP-BAND slippage on the stomach. Of these five, reoperation was required in four of 12 (33%) with hiatus hernia (P = 0.0093); three of nine (33%) with a motility disorder (P = 0.025); and three of six (50%) with both hiatus hernia and a motility disorder (P = 0.0076). Conclusions: We identify two factors, hiatus hernia and esophageal dysmotility, which are associated, both independently as well as in combination, with reoperation for LAP-BAND? slippage. Both patients and their physicians should consider these data when considering the LAP-BAND? as possible therapy for morbid obesity.