High reoperation rate after gastric banding

Reuters Health Information: High reoperation rate after gastric banding

High reoperation rate after gastric banding

Last Updated: 2017-05-19

By Andrew M. Seaman

(Reuters Health) - Nearly one in five patients with gastric bands required additional surgeries within about five years of the initial operation, researchers found.

"Bands have really gone out of style," said senior author Dr. Justin Dimick, of the University of Michigan in Ann Arbor. "Most surgeons have stopped using them."

Gastric bands were approved by the U.S. Food and Drug Administration in 2001, Dimick and colleagues noted in a report online May 17 in JAMA Surgery.

Complications from the devices often require additional operations, however. For example, the band can erode into the stomach or slip down and cause obstruction. Estimates of the proportion of patients who undergo additional operations after receiving a gastric band vary widely, Dimick's team adds, from as few as 4% to as many as 60%.

In the current study, the researchers analyzed data from Medicare on 25,042 people who received a gastric band between 2006 and 2013. The average age was about 58, and most were white and female.

Overall, 18.5% of patients needed at least one more surgery to revise or remove their gastric band.

In total, 4,636 patients needed another 17,539 surgeries for their device - an average of nearly four more surgeries per patient.

By 2010, with surgeons having moved away from using gastric bands, Medicare was spending more money on reoperations than on initial operations to implant the devices, the researchers found.

"Right now, more bands are going out than going in," said Dimick.

The researchers also found reoperation rates varied geographically ranging from about 13% to nearly 40%.

"The variation is from bad to horrible," said Dimick.

In an editorial, Dr. Jon Gould disagrees with the study authors' suggestion that insurance companies stop reimbursing for gastric bands.

"A committed surgeon and program, and the ideal patient with a similar level of commitment, are needed to achieve these best outcomes," wrote Gould, of the Medical College of Wisconsin in Milwaukee.

"No single bariatric procedure is appropriate for all patients," he added.

Dimick disagreed and said keeping the band available for a few patients may lead many others to get the device when they would have benefited from a different procedure.

Also, he pointed out, performing a gastric bypass in a patient who previously had a gastric band or sleeve may increase the risk of complications from adhesions.

"I think the most interesting thing about this is that surgeons have already voted with their feet by stop doing it in their practices," he said.

SOURCE: http://bit.ly/2qGbqfe and http://bit.ly/2qFDnUz

JAMA Surgery 2017.

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