Adjustable Gastric Banding - Part I

Since it was introduced in 1992, laparoscopic adjustable gastric banding, often called by one of its brand names, Lap Band, has been extensively used around the world, first in Europe and since 2001 in the United States after the procedure was approved by the U.S. Food and Drug Administration (FDA). In Europe, the adjustable gastric banding is the most common type of weight loss surgery performed. In the United States, Lap Band is the second most common form of weight loss surgery, right behind gastric bypass.

Adjustable gastric banding is a restrictive form of weight loss surgery in which an adjustable silicone band is placed around the upper part of the stomach. The silicone band squeezes the stomach, which becomes a pouch with an outlet that is approximately an inch wide. A plastic tube runs from the silicone band to a device, called a "port", which is situated just under the skin. Saline can be injected or removed through the skin, flowing into or out of the silicone band. Saline is what the surgeon uses to constrict or relax the band. With an adjustable gastric band, the patient returns to the surgeon as he or she loses weight and the band becomes looser to get more saline placed into the band so that restriction is maintained. These adjustments to the band are known as “fills”, and may be performed using an X-ray fluoroscope so that the radiologist can assess the placement of the band, the port, and the tubing that runs between the port and the band..

The first stomach band was produced by Obtech Medical of Sweden. This band is referred to as the Swedish Adjustable Gastric Band (SAGB), and was inserted during open incision surgery. Later, a US company, Inamed Health, designed the BioEnterics LAP-BAND Adjustable Gastric Banding System. This gastric banding system was introduced in Europe in 1993. When they were first manufactured, neither of these stomach bands were designed to be used with laparoscopic "keyhole" surgery. Then, in 2000, the first lower pressure, wider, one-piece adjustable gastric band was called the MIDband, and was produced in France. This stomach band was designed to be inserted laparoscopically. MIDband quickly become one of the leading bands used in France.

Adjustable gastric banding helps a morbidly obese patient lose weight by restricting the amount of food that can be put into the stomach at one time. With a gastric band around the stomach, the stomach has an hourglass shape, with a small pouch at the top that only holds about 50ml of food. This small pouch usually fills up with food very quickly, convincing the brain that the stomach is full. This message helps the patient to eat smaller portions, which will cause him to consume fewer calories. Even if the patient wants to eat more, the small size of the pouch on the upper stomach can only accommodate a very small amount of food, and excess food that is swallowed will be vomited. From the top stomach pouch, food trickles slowly through the band controlled opening into the lower stomach and then exits as normal into the small intestine.