Laparoscopic "Gastric Banding" in patients with morbid obesity

Laparoscopic "Gastric Banding" is a modern, minimally invasive technique to induce significant weight loss in morbidly obese individuals. If performed according to the established principles of elective surgery, the procedure has to be classified as a serious offer to a specific group of patients, w ho have, as yet, been confronted with the option of futile conservative the rapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, c onnected to a port-system. By the hourglass-like segmentation of the stomac h a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and - psychologically intended - inducing an earl y feeling of satiety. The complexity of the pathogenetic impulses leading t o severe nutritional obesity requires a serious risk/benefit appreciation w ith multidisciplinary responder-analyse. Apart from the main indications li ke overweight, patient history and obesity-associated disorders it is undis pensable to include the psychological status of the patient and his capabil ity of compliance into the decision-finding. With the inflatable inner surf ace of the band connected to the access port, the system is designed to per mit postoperative regulation of the therapeutic outcome by percutaneous sto ma size adjustment without further surgery. The placement of the band as we ll as the specific anatomical conditions of extremly obese patients involve severe risks such as primary organ lesions, post-operative pouchdilatation or "slippage" by herniation of the gastric wall. Therefore the technical p erformance of the implantation demands a high level of experience and pract ical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critica l look to the modification of the surgical procedure, the size of the impla nt, the pouch and the stoma.