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Articles: Paul E. O'Brien, John B. Dixon, Cheryl Laurie, Stewart Skinner, Joe Proietto, John McNeil, Boyd Strauss, Sharon Marks, Linda Schachter, Leon Chapman, and Margaret Anderson Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program: A Randomized Trial Ann Intern Med 2006; 144: 625-633 [Abstract] [Full text] [PDF]

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LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING FOR OBESE PATIENTS WITH BMI < 35 kg/m2

Antonio E. Pontiroli, Marco Laneri, Anna Veronelli, Paola Vedani, and Franco Folli   (3 January 2007)

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING FOR OBESE PATIENTS WITH BMI < 35 kg/m2 3 January 2007
Antonio E. Pontiroli, MD, Professor of Internal Medicine Università degli Studi di Milano, Ospedale San Paolo, Milano, Italy, Marco Laneri, Anna Veronelli, Paola Vedani, and Franco Folli Send rapid response to journal: Re: LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING FOR OBESE PATIENTS WITH BMI < 35 kg/m2 antonio.pontiroli{at}unimi.it Antonio E. Pontiroli, et al.	Sir, in their randomized trial, O’Brien and associates (1) showed that a surgical approach (laparoscopic adjustable gastric banding, LAGB) is superior to medical treatment in obese subjects with BMI < 35 kg/m2, i.e. in a “gray zone” of patients not recommended for a surgical approach according to current NIH guidelines (2), and confirmed the positive results of an italian retrospective survey based on decrease of BMI and disappearance of co-morbidities (3). During our 1996-2003 experience with LAGB (4), we were faced with subjects that, in spite of co-morbidities, were not eligible for LAGB (2) because of BMI <35 kg/m2. The local Ethics Committee stated that, in a comprehensive evaluation of the risk- benefit ratio, medical judgement should prevail on guidelines and for choosing a lower BMI threshold in selected cases, such as deteriorating glucose metabolism or arterial hypertension or personal concern for health. 15 patients, 1 man and 14 women, aged 34.9±1.51 years, height 162±1.1 cm, weight 90.2±1.42 kg underwent LAGB (LapBand, Inamed, Santa Barbara, CA, USA). Peri-operative mortality was 0.0%; diabetes or impaired glucose tolerance (3 cases) and arterial hypertension (2 cases) disappeared. Baseline 6 months 12 months 24 months BMI kg/m2 34.2±0.22 29.1±0.61* 28.9±0.68* 30.5±0.69* Waist (cm) 106.2±1.67 90.1±1.77* 88.6±1.87* 92.6±2.25* Hdl-cholesterol (mg/dl) 49.8±3.62 53.2±2.82 57.4±4.29* 56.2±6.69* Triglycerides (mg/dl) 146.9±21.84 92.0±8.47* 91.5±12.25* 120.1±17.62* Uric acid (mg/dl) 5.2±0.26 3.8±0.26* 3.8±0.31* 4.1±0.54 *p<0.05 or less vs baseline Also in light of the possibile prevention of co-morbidities of obesity (5), our data, similar to those obtained in patients with higher BMI (4), support results obtained by O’Brien (1), and are in favour of a re-examination of current NIH guidelines (2), also on the basis of a cost- benefit ratio (1, 4). References 1. O'Brien PE, Dixon JB, Laurie C, Skinner S, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006; 144: 625-633. 2. NIH Consensus Development Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med 1991; 115: 956–961. 3. Angrisani L, Favretti F, Furbetta F, Iuppa A, et al for the Italian Group for Lap-Band System: results of multicenter study on patients with BMI < or =35 kg/m2. Obes Surg. 2004; 14: 415-418. 4. Pontiroli AE, Pizzocri P, Librenti MC, Vedani P, et al. Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. J Clin Endocrinol Metab 2002; 87: 3555-3561. 5. Pontiroli AE, Folli F, Paganelli M, Micheletto G, et al. Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study. Diabetes Care. 2005; 28: 2703-2709.