In its early days, bariatric surgery proved it could generate effective weight loss.1,2 Conventional laparotomic surgery, however, presented a greater risk of morbidity and mortality in severely obese patients.1,3 Then, with the laparoscopic explosion, came the challenge: Laparoscopy created the hope of a minimally invasive solution to these at-risk patients but laparoscopic surgery was still considered a contraindication for this group of patients due to a deep operative field, massive visceral fat, hypertrophic and steatotic liver, and inadequate instrumentation. So, the challenge—and the opportunity—became overcoming the technical difficulties to create a surgical treatment that would be both effective and safe.
Thus, laparoscopic banding for the treatment of morbid obesity was born in 1991. Along with the manufacturer, Inamed Health, we worked through the first phase, the Animal Model phase, where we gradually refined the operative technique to the point of standardization and succeeded in creating the laparoscopic adjustable gastric band. Satisfied that the first phase was complete, we presented a video of laparoscopic banding in pigs at the June 1993 meeting of the American Society for Bariatric Surgery. The concept was received with great enthusiasm and we moved on to the second phase.4
We submitted a protocol for the device's application in human models to the Ethics Committee of the Centre Hospitalier Hutois in Huy, Belgium, where the project was approved unanimously. We then performed the first human laparoscopic adjustable gastric banding (LAGB) on September 1, 1993, in a procedure that lasted 3 hours, with no intra or postoperative complications.5 The patient has had good long-term weight loss and is still followed regularly.
From 1993 to 1994, 25 patients underwent this new procedure in the clinical trial program and in March 1994 we conducted the First International Workshop in Belgium with 30 surgeons in attendance. We developed the workshop in conjunction with the manufacturer to include live operations with complete interaction and training in the animal lab to give the participants the opportunity to learn the technique. At this time we also formulated our Ten Commandments (Table 31–1).6 Since that first training, hundreds of workshops have been held internationally and in the United States. The LAP-BAND was approved in the United States by the Food and Drug Administration in June 2001 and over 200,000 LAP-BANDs have been sold worldwide to date.
Table 31–1. Ten Commandments |Favorite Table|Download (.pdf)
Table 31–1. Ten Commandments
The recommendations which concerned at least the first 10 procedures the surgeons undertook after their participation at the LAGB workshop were termed the Ten Commandments:
Make a good patient selection. Avoid dealing with superobese patients. The ideal patient during the learning curve is a female with BMI 40–45 kg/m2 with gynoid-type obesity.
Know all the details of the operation. Study again and again the real-time video of the procedure. Follow the protocol ...
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