Laparoscopic Adjustable Gastric Banding in the Treatment of Morbid Obesity

T he epidemic of obesity requires an intervention that is both effective and broadly acceptable. Conventional medical programs have been ineffective. Traditional surgical approaches, such as gastric bypass and biliopancreatic diversion, are accepted by less than 1% of the severely obese each year. Laparoscopic adjustable gastric banding (LAGB) has been in clinical use for 8 years and it is timely to look at the developments in technique and to look at the outcomes for safety, effectiveness, and acceptability. Data are based on our clinical experiences and research reports derived from 1145 patients treated to date by laparoscopic adjustable gastric banding. We have also drawn on the published literature and on a systematic review of the literature about LAGB published by the Australian Safety and Efficacy Register of New Interventional Procedures–Surgical. Generally reports that have included more than 100 patients and 3 or more years of follow-up have been selected. Laparoscopic adjustable gastric banding has proved to be a safe procedure, 7 to 10 times safer than gastric bypass in terms of mortality, and associated with few perioperative complications. Late events have been more frequent with prolapse of the stomach through the band occurring in 15% of our initial patients and erosion of the band into the stomach in 3.2% of our initial patients. Both complications are treatable laparoscopically and have become less common with modifications of technique. Weight loss is gradual but progressive over the first 2 years and has stabilized at about 50% of excess weight lost for the next 4 years. There are major associated improvements in the multiple comorbidities of obesity including type 2 diabetes mellitus (DM), asthma, hypertension, dyslipidemia, asthma, gastroesophageal reflux disease, sleep disordered breathing, comorbidities of pregnancy, and the quality of life (QOL). Laparoscopic adjustable gastric banding has several attributes that potentially will enable it to overcome the community’s resistance to bariatric surgery. It has proved to be safe. It is highly effective in achieving good weight loss, major improvements in health, and improved QOL. Because of the laparoscopic placement, adjustablity, and the easy reversibility, LAGB can provide these benefits in a gentle and safe way.