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LAP-BAND® Adjustable Gastric Banding System versus |
The different techniques of gastric restriction introduced throughout the past years are not
equivalent. While the functional mechanism is similar in all techniques—earlier onset of satiety
and repletion with a small quantity of food, with consequent reduction of caloric intake—the
results are different efficaciously in terms of weight loss. Furthermore, mortality and morbidity
rates vary considerably.
Effectiveness, mortality and morbidity are determinants in the choice and fulfillment of an eminently "functional" procedure, such as the one performed in the treatment of pathologic obesity. Vertical-Banded Gastroplasty (VBG) (Fig.1) is the most common technique. First introduced in 1982 in the United States, it was performed by our staff between 1983 and 1990, then discontinued.
The method was clearly surpassed, both conceptually and technically, by the LAP-BAND® Adjustable Gastric Banding System (Fig.2), particularly when performed laparoscopically. Having direct experience in both Vertical-Banded Gastroplasty (VBG) and the LAP-BAND® Adjustable Gastric Banding System, the surgeons on the International Laparoscopic Obesity Surgery Team (ILOST) are among the few specialists worldwide capable of comparing both procedures.
The main differences are the following:
1. In Vertical-Banded Gastroplasty (VBG), the gastric "pouch" is obtained by suturing the gastric walls with mechanical staplers after creating a "window" in the stomach, still by means of mechanical staplers.
In the LAP-BAND® Adjustable Gastric Banding procedure, the stomach is neither sutured nor sectioned. The "pouch" is obtained by means of the banding itself, which is applied completely preserving the gastric innervation and irroration.
2. With VBG, the passage between the "pouch" and the remainder of the stomach is reinforced by a plastic mesh collar (Marlex), having a set circumference, resulting in a 1-cm diameter.
With the LAP-BAND System, the passage is governed by the banding, which, depending on the level of repletion, determines its diameter (ranging from total closure to maximum opening).
3. Mortality and morbidity caused by Vertical-Banded Gastroplasty (VBG) are definitely higher than those caused by Adjustable Gastric banding (LAP-BAND). Because the continuity of the gastric walls is interrupted in VBG by the mechanical staplers, there is a risk of dehiscence of sutures. This may result in peritonitis, gastro-enteric fistulas and subphrenical abscesses. Such risks are practically absent in LAP-BAND.
4. VBG is a "static" procedure. Once conducted, it cannot be anatomically reversed. The changes to the stomach (pouch and passage between pouch and remainder of the stomach) are permanent and irreversible from an anatomical point of view.
LAP-BAND is a "dynamic" procedure. It is totally reversible and can be progressively adapted to the patient's needs.
5. Compared to LAP-BAND, VBG is characterized by a distinctly higher percentage of repeat surgeries, not only numerically but also in terms of severity and technical difficulty, due to failures or complications. The anatomical irreversibility of VBG forces the surgeon to perform complex procedures in order to reinstitute the original gastric functionality.
6. LAP-BAND is a minimally invasive technique, particularly when performed laparoscopically. Therefore, besides its complete reversibility and possibility to adjust to the patient's needs, it constitutes a great progress in the surgical treatment of obesity.
Although sharing the same action mechanism of the LAP-BAND, VBG reveals some functional and technical "weak points" that lead to a remarkably higher number of mortalities and morbidities, as well as failure in terms of weight loss.
The weak points of VBG are as follows: