Mortality after laparoscopic adjustable gastric banding: results from an anonymous questionnaire to ASBS members.

Background: Laparoscopic adjustable gastric banding (LAGB) approved 6 years ago by the Federal Drug Administration is considered a safe and simple procedure for weight loss with a reported low mortality rate (0.05%) in the literature. The aim of the study was to probe the membership of the American Society for Bariatric Surgery (ASBS) to elucidate the incidence and possible causes of unreported operative and late mortality.

Methods: A simple questionnaire on early (30 days) and late mortality after LAGB and reoperation for banding was sent to 1,437 of 2,500 members of ASBS. Incidences and causes were studied.

Results: Of the 1,437 questionnaires sent, 453 (31%) were returned. Sixty-eight of the surgeons did not do any LAGBs, 350 had no operative mortalities, and 35 (9%) reported at least one operative mortality and had a total of 36 operative deaths and 19 late deaths, for a grand total of 55. Five additional deaths occurred after reoperations for LAGB, following removal, revisions, or conversions to another bariatric procedure. Of 62 deaths, the causes were: 20 (33%) cardiac origin, 11 (18%) thromboembolic, ten (16%) GI perforations, three (5%) bleedings, and 18 miscellaneous. Of all deaths, 40% occurred remotely from the band insertion date.

Conclusions: Although LAGB is technically simple, it carries a non-negligible short- and long-term mortality, with the majority being cardiac or thromboembolic. Late mortalities from LAGB and reoperations appear to be under-reported.