Causes of early mortality after laparoscopic adjustable gastric banding

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is 1 of the most used surgical procedures to treat obesity, with > 120,000 bands positioned around the world. LAGB is considered a safe and technically simple procedure, but it has many longterm complications, such as erosion, bleeding that requires reoperations, and sometimes even death of the patient. STUDY DESIGN: This article reviews the deaths after LAGB reported in the literature. Eight hundred eighty articles were reviewed from 1994 to May 2006, using the PubMed Web site and French, English, and Australian health Web sites. RESULTS: Data from 9,682 patients were collected from 24 articles and 48 (0.51%) deaths were reported. Twenty-eight patients died within 30 days of the operation, including 3 intraoperative deaths; 16 patients died 30 or more days after operation; and in 4 patients, the timing of death was not stated in the articles. Pulmonary embolism was the most frequent cause of death, in 11 (22.9%) patients, followed by myocardial infarction in 6 (12.5%) patients. Nine (18.7%) deaths were directly related to band positioning. Longterm mortality rates from LAGB, or reoperations from inadequate weight loss, could not be assessed. CONCLUSIONS: Although technically simple, LAGB has both short- and longterm complications that can be fatal for patients. We recommend surgeons consider perioperative pulmonary embolism prophylaxis and preoperative coronary evaluations on all patients.