Adjustable Gastric Banding (Lap Band)

In the early 1990s, bariatric surgeons in Europe and Scandinavia were in the early stages of investigating another procedure that would eventually become the least invasive and traumatic bariatric surgery to date. For the first time, surgeons explored the idea of implanting a restrictive device instead of cutting or stapling the stomach to reduce its capacity.

The first device of this kind was the Swedish Adjustable Gastric Band (SAGB), patented in 1985 by Obtech Medical in Sweden. Essentially, a silicone band was placed around the upper stomach to create a tiny stomach pouch. As with VBG, the procedure restricted food intake by producing an earlier feeling of fullness. But unlike VBG, the new stomach outlet wasn't as susceptible to stretching, and the patient could have the band removed (thus reversing the procedure) if desired.

The earliest versions of Swedish Adjustable Gastric Banding required open surgery and carried some problems. In addition, the weight loss results were not as good as the prevalent restrictive procedure, VBG. But the adjustable gastric banding concept soon regained momentum thanks to a modified version that surfaced in 1990 and included an inflatable balloon on the inner surface of the band. Tubing connected the balloon to a reservoir of liquid positioned beneath the skin. Using a needle, physicians could add or withdraw liquid to adjust the size of the band and, consequently, the rate of weight loss.

With the unique attributes of reversibility and adjustability, the gastric banding concept garnered even more interest. An American company, INAMED Health (Santa Barbara, CA), with 25 years of silicone manufacturing expertise, designed a next-generation version called the BioEnterics® LAP-BAND® Adjustable Gastric Banding System that could be implanted laparoscopically. The new design included multiple sized bands and accessories. As a result, the procedure became more accessible and patient-friendly due to its minimal invasiveness and shortened recovery. Patients could potentially stay just one night in the hospital and be home the following day.

In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.

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