Introduction Laparoscopic Adjustable Gastric Banding - An Introduction
Because of the high rates of complications with intestinal bypass procedures (see Bypass), the procedures mentioned before (see Scopinaro) as well as vertical gastroplasty (see Vertical Gastroplasty) were further developed and improved. Yet these procedures are still relatively invasive and irreversible, meaning that the original anatomic situation can not be reconstructed since the stomach arrangement is surgically modified to an extent beyond reconstruction. The most salubrious technique (see VGP, fig. 5) consists of diverting the stomach by creating a stomach pouch utilising mechanical staple sutures. As mentioned, an adjustable LAP-band was implanted for the first time in 1983 (see Horizontal Gastroplasty). It is considered part of the restrictive gastroplasties. Initiated by the introduction of the LAP-band insertion utilising laparoscopic techniques ("keyhole techniques"), this method began to spread rapidly in the early 90’s. To date more than 50,000 LAP-band surgeries have been performed. Since the LAP-band is implantable using minimal-invasive techniques ("keyhole techniques"), patients that are extremely, morbidly obese with heightened surgical risks benefit from the conservative entry to the abdominal cavity. Due to the absence of upper abdominal incisions, postoperative pain and the incidence of wound-healing complications and wound infections, as well as incisional hernias are drastically reduced. In addition, this method is cosmetically advantageous due to the expansion of many smaller skin scars, and it is fully reversible. The absence of lasting modifications to the anatomy of the intestinal tract, which are unavoidable in the course of the other procedures due to incisions, mechanical stomach sutures and/or bypassing of the small bowel, allows for relatively easy restoration to the original state by simply removing the band, which can be done using laparoscopic techniques in most cases.
The inner diameter of the band (adjustable gastric band diameter), meaning the inner passage width (gastronoma), can be controlled rather easily from the outside utilising the ventricular system. Up until now all systems were "fixed" systems, which could not be adjusted to individual circumstances except through repeated surgeries.
All these benefits are not diminished by the disadvantages vis-à-vis the other stomach-restriction procedures with comparable reductions in weight. With a reduction of excess weight averaging at about 50% in the long-term, the LAP-band is inferior though to the stomach bypass procedures, especially to biliopancreatic diversion (70%).