16 August 2008

Laparoscopic Adjustable Gastric Band (LAGB)
Laparoscopic gastric banding is the second most common weight loss surgery, after gastric bypass. It is one of the least invasive approaches to obesity because neither the stomach nor the intestine is cut. This procedure involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt to form a small pouch that serves as a new, much smaller stomach.

Using Laparoscopic tools, the surgeon places an adjustable silicone band around the upper part of the stomach. Squeezed by the silicone band, the stomach becomes a pouch with about an inch-wide outlet. After banding, the stomach can only hold about an ounce of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. No staples are used in this procedure, which is relatively new in the US. In this way the band can be tightened or loosened as needed. This can reduce side effects and improve weight loss. Unlike gastric bypass surgery, lap banding does not interfere with food absorption. For this reason, vitamin deficiencies are rare after lap banding.

The US Food and Drug Administration (FDA) approved an AGB system in 2001 that can be put in place with a laparoscope (a small thin tube with a video camera attached) rather than with an open incision for patients who are morbidly obese, as indicated by a Body Mass Index (BMI) of 40 or more.
The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits.

Vertical Banded Gastroplasty (VBG) or Stomach Stapling
Vertical banded gastroplasty also involves a plastic band placed around the stomach. In addition, the surgeon staples the stomach above the band into a small pouch.
This pouch is not completely closed off from the rest of the stomach. A small opening, about 0.25in. across, allows the partially digested food to move into the rest of the stomach and then into the intestines. The size of the pouch is small enough that you can eat only 0.5cup to 1cup of food before feeling uncomfortable.
Vertical banded gastroplasty results in less weight loss, compared with other surgeries. It also has a higher complication rate. For these reasons, vertical banded gastroplasty is less common today. Only 5% of bariatric surgeons still perform this surgery

VBG and AGB may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes - small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The physician performs the surgery while looking at a TV monitor. Laparoscopic gastric surgery usually reduces the length of hospital stay and the amount of scarring, and often results in quicker recovery than an “open” or standard procedure.Persons with a BMI of 60 or more or persons who have already had some type of abdominal surgery are usually not considered as a candidate for the laparoscopic technique.

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