Why do Patients who Underwent Laparoscopic Adjustable Gastric Banding Surgery, Decide to Remove their Band, a Retrospective Cohort Study

Background: Obesity is becoming more and more prevalent in western society. It is estimated that obesity will become a serious burden to society in the next century. Surgery has been shown to be the most effective method for treating morbid obesity. Laparoscopic gastric banding (LGB) is a common restrictive type of bariatric surgery in Israel. Despite the success of the surgery, some patients choose after a period of time to remove the band. Objectives: To map the characteristics of LGB patients who chose to remove the band without an objective medical reason. In addition, to assess the rate of complications, quality of life and degree of weight loss among patients who decided to remove the band in comparison to patients who didn't remove the band. Methods: A retrospective case - control study among patients who underwent LGB surgery in Surgery ward A at the Soroka Medical center. We have recruited 360 patients to the study, who were operated in the years 2006-2011. Patients who chose to remove the band were compared to patents who did not remove it. Data was collected from the hospital computerized patient data system. In addition a telephone interview was completed at least two years after the band placement, and at least a year after its removal in the cases group. Demographic and physiological data were collected. A quality of life assessment was performed by a Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire. Results: The group of patients that removed the band where older and had the band for a longer period on average. Weight and BMI on the day of the interview was distinctly higher in the band removal group, which were at least a year after removal of the band. However the total weight lost, lowest weight and minimal BMI reached did not differ between the two groups. Immediate and long term complications rates were higher with the band removers. The leading reasons stated by the patients for band removal were: frequent vomiting, eating discomfort and band-related complications. Conclusions: Band removers were not found to be different from non-removers pre-band characteristics or general surgical result. Two main differences were noted: the removal group had a higher rate of complications, and secondly the subjective feeling of intolerance to the band was stated as the main reason for band removal. Given these findings we learn about the importance of the band effect on the patient's quality of life. A Patient who does not adjust to the band's effects on quality of life is prone to remove it, even though the band fulfills its main role of weight loss. We recommend improving patient preparation and support before and after the operation by a multidisciplinary team designed to help the patient adjust to life with the band.