GASTRIC BANDING :

Another way to limit food intake is to place a constricting ring completely around the top end(fundus) of the stomach, creating an hour-glass effect. Except that the ring has to be placed near the upper end of the stomach, just below the junction of stocach and esophagus. This idea of gastric banding has been around for quite a number of years, and was pursued in Europe and Scandinavia particularly. Initially, readily available material such as arterial graft was used for the band. The results, however,were not as good as RGB or VBG and the concept has only become popular with the development of modern bands design for the task and techniques to measure the size of the "stoma" created under the band and associated pressures. An ingenious varient, the inflatable band was developed by Dr Kuzmak (Kuzmak, Yap et al. 19990) who devised a band with an inflatable balloonas its lining. This balloon was connected to a samll reservior 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 patients the discomfort of a large incision.Since this hour glass like device, only affects constricts the upper stomach, there is no malabsorptive effect and it acts as a pure restrictive operation. Like VBG, the favorable consequences are absence of anemia, dumping and malabsorption, while the disadvantages include the need for the strict patient compliance. Long term results of this device are not yet available, but logic would suggest they are likely to be comparable to VBG results with an unknown additional effect due to manipulation of the inflatable balloon. At the present time there are two devices on the world market. The LapBand manufactured by Bioenterics, Carpenteria, California and the Obtech Medical AG. Neither of these is freely available in the USA at this time, through the LapBand is currently progressing through FDAtrails.

Listing of Complications Following Gastric Binding

Operative:

1. Splenic Injury
2. Esophageal Injury
3. Conversion to Open Procedure
4. Wound infection

Late:

1. Band slippage
2. Reservior deflation/leak
3. Failure to lose weight
4. Presistent vomiting
5. Acid reflux