19 Laparoscopic Adjustable Gastric Banding: Technique

Abstract

It’s now 19 years since the laparoscopic adjustable gastric band (band) was first used to help morbidly obese patients. Much has changed in that time. The operation we do now for insertion of a band bears little resemblance to how it was done first by Belechev in 1994. The changes in technique evolved as we tried to reduce the rate of gastric prolapse, and reflux, after band insertion. Larger, softer, lower pressure bands are placed higher on the stomach, often with a concomitant crural or hiatal hernia repair. Bands are adjusted slowly, aiming to control hunger and increase satiety, rather than act purely as a restrictive tool. All bariatric operations have their strengths and weaknesses. The band’s strength is its safety, adjustability, and ease of removal. Its weakness is the need for reoperation. However, that problem is decreasing in frequency with the changes mentioned above. Band revision is safer than alternate procedures. A band can be safely revised, and the patient then continues their journey to control their weight. All the various procedures can and do fail and if a band fails, alternate procedures can be offered. LAGB is still a very effective weight loss tool and given the enormous surge in obesity, it will remain attractive to many patients who are nervous of more aggressive procedures and their complications. Adequate band adjustment in long-term follow-up is the cornerstone of success with a lap band. Proper surgical technique during band insertion is essential for long-term success with a band.

The band can be inserted by a standard 5-port technique or by single incision at the umbilicus.