[Laparoscopic surgery in morbid obesity: adjustable-ring gastroplasty. 320 cases]

Stapling gastroplasty has long been the standard operation in France to treat morbid obesity. Laparoscopic adjustable gastric banding has become an attractive method, because it is minimally invasive and allows modulation of weight loss. In our technique, the ring is placed in a high position, just beneath the gastro-oesophageal junction. Three hundred and twenty patients have been operated from April 1995 to February 1998 (271 females and 49 males, mean age 39.2 years); their mean weight was 121.6 kg, and their mean BMI was 44 kg/m2. Two rings have been changed for leakage. Two rings have been removed, because of postoperative sigmoiditis and a late gastric erosion. Three access-ports have been removed for infection. Eleven cases of pouch dilatation have been observed, 4 of which required reoperation. Mean loss of excess weight was 47% at 6 months, 62% at one year, and 72% at two years. This favorable outcome led us to propose laparoscopic banding to all patients with morbid obesity instead of stapling gastroplasty.