Superior weight loss with patient-driven, fluoroscopically guided band adjustment following laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding has led to variable weight loss results in the United States. We believe a patient-driven, fluoroscopically guided method of band adjustments results in the most successful weight loss. METHODS: Between November 2001 and October 2003, 248 patients underwent laparoscopic adjustable gastric banding. Patients underwent band adjustments when consuming solid food, not sensing satiety, and not experiencing regular weight loss. Adjustments were done under fluoroscopic guidance. Data were collected at the time of adjustments and through periodic telephone interviews. RESULTS: Weight loss data are available for 141 patients with a minimum of 6-month follow-up. Patients were divided into 3 groups by length of follow-up: 6 to 12 months, 12 to 18 months, and 18 to 23 months. Mean preoperative weight and body mass index for all 141 patients were 144.4 kg (range, 92.3 to 214.1) and 50.9 kg/m2 (range, 35.6 to 73.8), respectively. Following a mean of 4.1 (range, 0-10) adjustments, percentage excess weight loss was 35.3% (range, -2.1 to 81.0), 44.4% (range, 13.6 to 98.9), and 52.1% (range, 13.3 to 80.1) for the 6 to 12, 12 to 18, and 18 to 23 month follow-up periods, respectively. CONCLUSIONS: Our data suggest that patient-driven band adjustment results in superior weight loss. Additionally, fluoroscopic guidance may optimize the result of each adjustment and minimize the incidence of adjustment-related complications.