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Recommendations for the management of Morbid Obesity in the U.K.
The National Institute for Clinical Excellence has issued recommendations to the NHS on the use of gastric surgery for the treatment of morbid obesity. NICE has recommended that weight-loss surgery, including the LAGB technique should be available as a treatment option for people with morbid obesity. In a review of 17 randomised controlled trials NICE concluded, surgery for people with morbid obesity is associated with significant weight loss that is maintained for at least 8 years, whereas there is little sustained weight loss with conventional (medical) treatment in this group of patients. Surgery is also associated with improved quality of life and reduced co-morbidity. There are significant risks attached to surgery, although these are thought to be outweighed by the benefits.
For the purposes of the NICE guidance, people are considered to have morbid obesity if they have a body mass index (BMI) of 40 kg/m2 or more or they have a BMI of between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, diabetes, high blood pressure) that may be improved if they lose weight.
Protocol and procedures
The first consultation is important to make an appropriate medical assessment of the patient to ensure that this treatment option is correct. At the consultation the patient is given a full explanation of the details of the procedure and a 'Lap-Band handbook' to read following the consultation.
Patients are admitted on the day of surgery. The operation is performed through four 5 mm and one 12 mm incisions. The in-patient stay is 2 nights. Patients are recommended to take a week off after surgery. In the first 2 weeks patients take a fluid diet, in the second two weeks a pureed diet after which they eat small amounts of solid food. Patients are followed up periodically and the Lap-Band is adjusted (tightened) as an outpatient when necessary to achieve the weight loss required. Once the target weight loss has been achieved the Lap-Band is left in place. It therefore offers a cost-effective permanent solution for the morbidly obese patient in contrast to short-lived temporary solutions such as the intra-gastric balloon.
References:
O'Brien PE and Dixon JB Lap-Band: Outcomes and Results Journal of Laparoscopic and advanced surgical techniques 2003; 13: 265-270
Chapman A Kiroff G Game P et al Systematic review of Laparoscopic adjustable gastric banding in the treatment obesity Adelaide South Australia: ASERNIP-S report No 31, 2002
Evans JD, Scott MH, Brown AS and Rogers J. American Journal of Surgery 2002; 184, 97-102.
Dixon JB and O'Brien PE Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002; 25: 358-363
Dixon JB Dixon JF O'Brien PE Improvements in insulin sensitivity and beta cell function (HOMA) with weight loss in the severely obese. Diabetes Medicine 2003; 20: 127-134
Dixon JB O'Brien Gastroesophageal reflux in obesity: The effect of Lap-Band placement. Obesity Surgery 1999; 9: 527-531.
Dixon JB Schacter LM O'Brien PE Sleep disturbance and obesity: Changes following surgically induced weight loss. Arch Intern Med 2001; 161: 102-106
Dixon JB Dixon JF O'Brien PE Depression associated with Obesity: Changes with weight loss. Int J Obesity 2003; 27: S149
Please note that this information is designed to help promote understanding of the conditions described. It does not serve as a guide to diagnosis or treatment. You should always consult your General Practitioner who is qualified to give you expert medical advice. Surgical techniques are constantly being modified and improved- please ask your surgeon for information regarding the technique, associated risks and complications. As with all medical treatments no guarantee of success is offered or implied
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