Chapter 18

Bariatric surgery offers a long-term solution for the problem of severe obesity. The major benefits of sustained weight loss include the reversal of numerous obesity-related illnesses, making bariatric surgery one of the most powerful therapies in current clinical practice. Laparoscopic adjustable gastric banding (LAGB) is proving to be an acceptable form of bariatric surgery because of its safety, effectiveness, long-term weight-loss maintenance, and reversibility. The success or failure of this type of operation depends more than almost any other on the patient's cooperation and compliance. The patient needs to be fully informed about obesity as a disorder, the operative procedure, possible complications, warning signs and symptoms, and the postoperative follow-up. In 2003, worldwide adjustable gastric banding was one of the three leading procedures, with 24% of all bariatric procedures.1,2

The adjustable gastric band is a 12 mm wide soft silicone band with an elastic balloon that can be inflated by injection, according to individual need. The band is fitted around the upper part of the stomach, dividing it into two sections: the smaller section is above the band and has a capacity of about 10–20 mL (pouch), and the larger section is below the band (Figure 18–1). This constriction is called stoma. Besides the obvious assets of laparoscopic surgery, the proposed advantages of gastric banding include reversibility and the possibility of adjusting the band's stoma size. It should be hoped and expected that the treatments for obesity available today will be superceded by better treatments in the next 20 years. It is an asset of the band that it can be removed easily and the stomach anatomy remains intact. Removing the band is a minor laparoscopic procedure that can be performed on an outpatient basis, but this results in weight regain. Adjustable gastric banding has become popular since 1985 as a means of achieving gastric restriction and treating morbid obesity. Adjustable silicone gastric banding as described by Kuzmak3 and the Swedish adjustable gastric banding proposed by Hallberg and Forsell4 permit regulation of gastric restriction.

###### Figure 18–1.

Adjustable gastric banding with gastropexy.

Early experience gained in Europe with the LAP-BAND System made by Bioenterics (Inamed Corp., USA) led to repeated modification of the technique and resulted in great improvements in the outcome.5,6 As with the adjustable band, the so-called Swedish Adjustable Gastric Band (SAGB, Obtech AG, ETHICON), which makes a smaller pouch, significantly reduced the postoperative complication rate.7,8 Meanwhile, an increasing number of different bands are now available (Table 18–1).

Table 18–1. Different Brands and Features

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