Outcomes of Laparoscopic Adjustable Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is a proven effective procedure for the treatment of morbid obesity. The most common bariatric procedure outside of the United States, LAGB has increased rapidly in the United States since its introduction in 2001. Touted advantages of LAGB over Roux- en-Y gastric bypass (RYGB) include its technically simpler laparoscopic approach, reduced perioperative morbidity, and mortality, adjustability, and reversibility. Numerous studies from Europe and Australia had documented significant and durable weight loss with improvement or resolution of associated comorbidities following LAGB placement with follow-up beyond 5 years, and contemporary reports from the United States parallel international results. Despite favorable outcomes with LAGB in most recent publications, disappointing results with LAGB continue to be reported in some series, with high rates of reoperation, band loss, and poor weight loss. Two factors account for these confl icting results. The replacement of perigastric dissection with the pars fl accida technique for band placement has dramatically decreased the rate of complications and band extirpations. Weight loss is dependent upon post operative follow-up and appropriate band adjustments. Frequent, clinically based adjustments are necessary to maintain the proper degree of restriction and successful weight loss. LAGB placement using the pars fl accida technique, combined with appropriate adjustment schedules and follow-up are mandatory for optimal outcomes.