[Laparoscopic gastric banding in 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, who have, as yet, been confronted with the option of futile conservative therapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, connected to a port-system. By the hourglass-like segmentation of the stomach a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and--psychologically intended--inducing an early feeling of satiety. The complexity of the pathogenetic impulses leading to severe nutritional obesity requires a serious risk/benefit appreciation with multidisciplinary responder-analyse. Apart from the main indications like overweight, patient history and obesity-associated disorders it is indispensable to include the psychological status of the patient and his capability of compliance into the decision-finding. With the inflatable inner surface of the band connected to the access port, the system is designed to permit postoperative regulation of the therapeutic outcome by percutaneous stoma size adjustment without further surgery. The placement of the band as well as the specific anatomical conditions of extremely obese patients involve severe risks such as primary organ lesions, post-operative pouch dilatation or "slippage" by herniation of the gastric wall. Therefore the technical performance of the implantation demands a high level of experience and practical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critical look to the modification of the surgical procedure, the size of the implant, the pouch and the stoma.