Horizontal gastroplasty: gastric band
Lubomir I. Kuzmak developed the adjustable lap band technique in Livingston, NJ, USA and applied it for the first time in 1983. It was developed as an advancement of restrictive procedures for adiposity surgeries, without the necessity for incision, clipping, and bypass procedures on stomach and bowels. Initially it was inserted using an "open" technique by way of an upper abdomen laparotomy (incision in the upper abdomen to enter the abdominal cavity). Because a silicon ring with an adjustable inner diameter is used, the term used for it is Adjustable Silicon Gastric Band (ASGB). Since the 90s the lap band was implanted more and more often by using laparoscopic techniques ("keyhole-surgery"), which was the actual reason for the overwhelmingly growing worldwide popularity and application (Laparoscopic Adjustable Silicon Gastric Banding, LASGB).
- Abb. 6: Adjustable gastric band
A band made of silicon divides the stomach into a small preset stomach pouch and the remaining main stomach whilst creating an adjustable pouch exit (gastrostoma). The inner diameter of this band is adjustable. Adjustments are made by filling liquids into the infusion reservoir (chamber system, port system) placed on the chest or the abdominal wall, which in turn is connected to the LAP-band by a flexible tube (catheter). The gastrostoma may be constricted or widened by simply puncturing this chamber. The material used, a silicon elastomer, has proven itself in a wide variety of medical applications. Silicon distinguishes itself by its elasticity, tissue compatibility, and durability – and the absence of degradation by body reactions. The body forms a coat of fibrose tissue around the material, which will then remain in the organism without triggering any reactions. Rejections occur only in very rare cases. Until now no incompatibility reactions caused by LAP-bands have been reported. The severe, if rare, side effects commonly known from breast implants are not possible in LAP-bands. In breast prostheses liquid silicon was used, which is capable of triggering heavy tissue reactions and is therefore no longer in use.