24 Nov 2011
By Tan Lay Eng
Many are now rejecting lapband surgery for newer procedures which give better long-term results
A previously popular weight-loss procedure to tie up the stomach and reduce its size is falling out of favour among severely overweight people who choose the radical option of surgery. Instead, most are now opting for procedures to bypass or remove most of the stomach.
Public hospital doctors say the long-term results of laparoscopic gastric banding (lapband) have not been as good as they first promised.
Lapband surgery is still routinely done in at least one private hospital here, but since the other options became available, five restructured hospitals have more or less stopped putting in gastric bands.
In fact, Tan Tock Seng Hospital (TTSH) has not done any lapband surgery since 2007, while the National University Hospital (NUH) and Singapore General Hospital (SGH) have done none in the last two to three years. Each year, about 10 per cent of the 400 to 500 overweight patients at SGH undergo surgery.
At Khoo Teck Puat and Changi General hospitals and at least one surgeon’s practice in Mount Elizabeth Medical Centre, lapband procedures make up no more than 10 per cent of bariatric operations (surgery to treat the obese).
In a lapband procedure, a band is tied around the upper part of the stomach so the patient feels satisfied with a smaller amount of food. It was first carried out in 1993 in Australia and Belgium and introduced in Singapore about a decade ago. Encouraging early results made it the surgery of choice to tackle severe obesity.
A Swiss study published in Obesity Surgery journal in 2006, however, found complications associated with the procedure and a high loss of effectiveness after an eight-year follow-up of 317 patients.
As the band is a foreign body, it can erode or slip and cause pain, infection, bleeding, obstruction of the stomach and nausea.
One-third of the patients in the study developed such complications, most commonly band erosion and slippage. More than 20 per cent needed additional operations. The failure to shed at least a quarter of excess weight increased from 13.2 per cent after 18 months to 36.9 per cent at seven years.
One such patient in Singapore who failed to lose the required amount of weight is Mr Chan, aged 53. The human resource manager with a trading company, who does not wish to reveal his full name, had lapband surgery five years ago but put back all the weight he had lost and more. His diabetes and hypertension conditions also did not improve.
In February, he had a painful operation at TTSH to remove the gastric band. At the same time, he had a Roux-en-Y gastric bypass, a procedure that creates a small stomach pouch and connects it directly to the middle of the small intestine.
This time, the 1.7m-tall man dropped from 102kg to 72kg in seven months. His diabetes is a thing of the past. He now takes reduced amounts of medication for hypertension and high cholesterol.
Although there are no local figures, detractors of lapband surgery say it is not ideal. Dr Jaideepraj Rao, director of Bariatric Surgery (Weight Loss) Programme at TTSH, said he has removed eight bands this year from patients who sought his help because of complications.
lltan@sph.com.sg
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