Laparoscopic Adjustable Silicone Gastric Banding Versus Vertical Banded Gastroplasty in Morbidly Obese Patients: A Prospective Randomized Controlled Clinical Trial

The introduction of laparoscopic surgery has created a revolution in the field of bariatric surgery. Laparoscopic procedures have progressively replaced traditional open bariatric procedures in both Europe and North America. Although gastric bypass1–3 and duodenal switch4 currently represent 80% of laparoscopic bariatric procedures in the United States and Canada,5 in Europe laparoscopic gastric restrictive procedures still represent the majority of bariatric procedures.6,7 Two reasons explain this disparity. First, different diet habits lead to a better response in European patients following gastric restrictive procedures. Second, most European patients present for bariatric surgery with a body mass index (BMI) between 35 and 50 kg/m2, and superobese patients (BMI >50 kg/m2) remain a rare entity. Gastric restrictive procedures frequently fail in the superobese patient population.8,9 Laparoscopic adjustable silicone gastric banding (LASGB) was the first bariatric procedure to be performed by a laparoscopic approach.10–12 Introduction of LASGB into clinical practice was an immediate success. It caused the rapid growth of bariatric programs in surgical departments throughout European countries, where these procedures were limited to a few centers in the past. Despite the recent widespread use of LASGB, long-term outcome evidence is limited.13 Moreover, few studies provide precise data for long-term follow-up.14–16 Some studies even report disappointing long-term results.17,18 To the best of our knowledge, there are no prospective studies or randomized controlled trials comparing LASGB to other laparoscopic bariatric procedures. The randomized trial published by Nilsell et al,19 comparing adjustable gastric banding and vertical banded gastroplasty (VBG), was related to open procedures. To date, randomized controlled trials have addressed different technical variations of one laparoscopic bariatric procedure,20 or they have compared the traditional open approach with a minimally invasive approach for the same procedure.21–23 To fully validate LASGB, we must gauge it against other restrictive laparoscopic procedures. The aim of this study is to compare LASGB with laparoscopic vertical banded gastroplasty (LVBG). LVBG was the most popular gastric restrictive procedure during the prelaparoscopic era. In our experience, LVBG continues to provide satisfactory outcomes when performed with a minimally invasive approach.24 Therefore, it is appropriate for comparison with LASGB.