Gastric banding for morbid obesity

Recent advances in laparoscopy have renewed the interest in gastric banding techniques for the control of severe obesity. This method entails encircling the upper part of the stomach using bands made of synthetic materials, creating a small upper pouch that empties into the lower stomach through a narrow, non-stretchable stoma. The reduced capacity of the pouch and the restriction caused by the band diminish caloric intake, depending on important technical details, thus producing weight loss comparable to vertical gastroplasties, without the possibility of staple-line disruption and lesser incidence of infectious complications. However, distension of the pouch, slippage of the band and entrapment of the foreign material by the stomach have been described. To reduce the likelihood of these occurrences, reviewing the literature of the past 20 years is important to surgeons new in the bariatric field. Understanding the development of this procedure helps in avoiding mistakes made during the evolutionary process. The simplicity and non-invasiveness of the technique, low morbidity, ease of revision, and especially its complete reversibility, make gastric banding a first-line choice in bariatric surgery. However, as in other pure restrictive methods, and perhaps more important than surgical refinements, patient compliance with the behavioural changes imposed by the procedure is critical for a successful outcome. (C) 1999 Lippincott Williams & Wilkins.