Open versus laparoscopic adjustable silicone gastric banding - A prospective randomized trial for treatment of morbid obesity

Objective To perform the first prospective trial of laparoscopic versus ope n adjustable silicone gastric banding (ASGB) in patients with morbid obesit y. Summary Background Data Vertical banded gastroplasty has been used for many years to treat morbid obesity, but the size of the stoma has remained a so urce of failure after the procedure. ASGB has the advantages of maintaining gastric integrity and the potential for readjustment of the band, if neede d. It has been suggested that laparoscopic ASGB, recently introduced to red uce postoperative complications and hospital stay, has a negative impact on outcome. Methods Fifty patients with morbid obesity of >5 years' duration and a body -mass index (BMI) > 40 kg/m(2) were randomized to undergo laparoscopic or o pen ASGB. The difficulty of the procedure, surgical time, postoperative com plications, and hospital stay were assessed. Stoma adjustments, long-term c omplications, readmissions, weight loss, and BMI were determined. Results All procedures were successfully carried out. Of 25 patients assign ed to laparoscopic ASGB, 2 were converted to an open procedure. Surgical ti me was significantly longer for laparoscopic ASGB (150 minutes vs. 76 minut es for open ASGB). There was no difference in complications. Mean hospital stay was 5.9 days for the laparoscopic procedure Versus 7.2 days for open A SGB (p < 0.05). The total number of readmissions (6 vs. 15) and overall hos pital stay in the first year (7.8 vs. 11.8 days) were lower after laparosco pic ASGB (p < 0.05). Weight and BMI were reduced significantly in both grou ps, but there was no difference between the groups. Conclusion Laparoscopic and open ASGB were equally effective in terms of ea rly (first-year) weight loss, reduction of BMI, and postoperative complicat ions. The laparoscopic procedure was associated with a shorter initial hosp ital stay and fewer readmissions during follow-up and is therefore the pref erred treatment in morbidly obese patients undergoing ASGB.