Multicenter Prospective Randomized Clinical Trial of Plicated Laparoscopic Adjustable Gastric Banding

Morbid obesity is a major problem affecting the lives of millions in the US. As of 2008, overall prevalence of obesity as defined by body mass index (BMI) greater than 30 kg/m2 was 33.8%.1 Obesity adversely affects the lives of millions of Americans by increasing the risk for co-morbid conditions such as diabetes mellitus, obstructive sleep apnea, hypertension, and even certain cancers.2-4 The laparoscopic adjustable gastric banding (LAGB) procedure is a safe, effective, and durable treatment option for refractory morbid obesity and its related health consequences.5 This minimally invasive technique is now a popular approach for bariatric surgery, and it offers obvious advantages such as decreased operating time, shorter hospital stay (often same day surgery), and favorable complication rates as compared with other bariatric procedures.4,5

One of the biggest drawbacks to LAGB [when compared to the 'gold standard' of bariatric surgery: Roux-en-Y gastric bypass] is that patients tend to have a slower, less dramatic weight loss in the first few months after surgery.5-7 In addition, the LAGB procedure is associated with an approximate 3% chance of "band slippage" complications.8 In order to address some of these issues modifications in the technique of LAGB surgery have been made. Techniques such as a "pars-flaccida approach" to tissue dissection and the placement of plication sutures to "anchor" the redundant stomach around the newly placed band device were introduced and shown to have positive results in reducing band complication rates.8 More recently, sleeve gastrostomy procedures (the greater curvature and significant portion of the body of the stomach is resected over a sizing bougie; leaving a narrow 'sleeve' of stomach) have also become popular in treating patients with morbid obesity.9 Combining these concepts, a modified technique of plicated LAGB was introduced.

At the time of LAGB placement, plication sutures can be placed along the body & greater curvature of the stomach to "tighten" and "cinch up" the stomach in a sleeve-like orientation. It was recently reported that this modified technique of plicated LAGB could result in lower band slippage complication rates and faster, early weight loss.8

However, as of today there exists no prospective, randomized study that compares the outcomes of this modified surgical technique to the standard procedure (SLAGB).

This is a prospective randomized clinical trial comparing PLAGB versus SLAGB. All adult (age older than 18 years) morbidly obese patients meeting NIH criteria for bariatric surgery (BMI > 35 + co-morbid disease or BMI > 40) who are undergoing bariatric surgery at the Duke Metabolic and Weight Loss Surgery Center and the University of Pittsburgh Medical Center will be recruited. All enrolled patients will be randomly assigned to either the SLAGB (control) group or the PLAGB (study) group. Variables to be studied include patient age, gender, ethnicity, co-morbid disease conditions, height, weight, BMI, intra-operative data such as operative time and blood loss, and post-operative outcomes including length of hospital stay, complication rates, weight loss, and co-morbid disease resolution. In addition, each patient will complete standardized surveys rating their satisfaction from surgery, their quality of life (OWL-QOL-17), and their sleepiness (Epworth Sleepiness Scale) at three distinct time intervals: pre-operatively and at weeks 24 & 48.