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Adjustable Gastric Banding (AGB)

Most bariatric treatments for the morbidly obese are often complex and require major reconstruction of the patient’s internal organs. For many people, this idea is unwelcoming, but as improvements in bariatric surgery unfold, new and safer ways to help control weight and improve overall quality of life are being explored.

One such way to limit food intake is to place a constricting ring completely around the top end of the stomach, creating an hour-glass effect (gastric banding). The ring has to be placed near the upper end of the stomach, just below the junction of stomach and esophagus.

The idea of gastric banding has been around for quite a number of years, and was pursued in Europe and Scandinavia particularly. Initially, readily available materials such as arterial graft, was used for the band. The results, however, were not as good as VBG and the concept has only become popular with the development of modern bands designed for the task and techniques to measure the size of the stoma created under the band and associated pressures.

An ingenious variant, the inflatable band was developed by the bariatric surgeon, Dr. Kuzmak who devised a band with an inflatable balloon as its lining. This balloon was connected to a small reservoir which is placed under the skin of the abdomen, through which, the balloon can be inflated, thus reducing the size of the stoma, or deflated thus enlarging the stoma.

Even more ingenious, has been the development of models which can be inserted laparoscopically, thus saving the patient the discomfort of a large incision.

Since the hour glass configuration only constricts the upper stomach, with no malabsorptive effect, it acts as a pure restrictive operation.

At the present time there are two devices on the world market. The LapBand manufactured by Bioenterics, Carpenteria, California and the Obtech device produced in Sweden by Obtech Medical AG. At this time, only the LapBand is freely available in the USA, having completed U.S. trials and been approved for use by the FDA.

Products like the LapBand are adjustable elastic bands which can be placed around the upper stomach to create a small 15cc (one half ounce) pouch with a narrowed outlet. The outlet size can be adjusted by injecting saline into a small reservoir (port) placed under the skin at the time of surgery, and connected to the band by an I.V. tubing. The pouch fills quickly with solid food and empties slowly to relieve hunger and produce a feeling of fullness.

The adjustable gastric banding technique is favorable to most because it does not require major reconstruction of the stomach and small intestine. It is also the choice of many because the band (as its name suggests) can be adjusted overtime to help compensate for any discomfort or emergencies.