History of Lap-Band (R): from dream to reality

Background: Laparoscopy in severely obese patients is a surgical challenge due to the deep operative field, massive visceral fat, hypertrophic and ste atotic liver and inadequate instrumentation. However, performing bariatric surgery by laparoscopy permits a minimally invasive procedure in patients w ho are usually considered high risk because of their morbid obesity, The ch allenge was to overcome technical difficulties of laparoscopy in the morbid ly obese. Method: We needed to develop a new surgical protocol for the gastric approa ch in severely obese patients. The existing silicone band could not be used for laparoscopy, and a new prototype of the silicone band for laparoscopic use was designed. Because of ethical reasons, we began this work on the an imal model. In an animal lab program using pigs, we refined the surgical te chnique of the laparoscopic approach. A new design of the adjustable silico ne band for laparoscopic use was developed. Results: After a I-year animal lab program and approval by the ethics commi ttee, we performed our first human laparoscopic adjustable gastric banding on September ist, 1993. Conclusion: The development of the Lap-Band(R) from concept to animal lab, ending in clinical application, has been an advance in bariatric surgery.