Technical tips for laparoscopic gastric banding: 6 years' experience in 2800 procedures by a single surgical team

Objective: We present a modified method for laparoscopic gastric banding (LGB) based on the extensive personal experience of a single team, and propose a list of comprehensive technical tips that should shorten the operation time, reduce the hospital stay, and minimize the complication rate. Background: Gastric banding is probably the most commonly performed bariatric procedure in Europe and Australia, as well as in Israel. Because of its minimal invasiveness, efficacy, safety, reversibility, and adjustability, it is considered a breakthrough in bariatric surgery. Methods: From December 1997 to December 2003, 2800 morbidly obese patients underwent LGB performed by a single team. All patients strictly met the criteria for surgery as defined by the National Institutes of Health (NIH). We excluded patients with psychiatric disorders, profound incompliance, mental retardation, and portal hypertension. Our modified technique focused especially on positioning of the port sites, retro-gastric transit of the band, band fastening, and placement of the injecting port (IP). Results: The mean overall operative time was 32 minutes. The mean hospital stay was 23 hours. Follow-up took place between 24 to 96 months, and mean body mass index (BMI) postsurgery was 29 ± 3.2. The overall morbidity rate was 10%. Gastric perforation occurred in 5 patients. No operative or immediate postoperative deaths occurred. One patient died 8 days postoperatively due to massive pulmonary embolism. Conclusion: Our satisfactory results were achieved by employing the proposed technical tips and adapting "do and don't" rules. We believe that the following compelling data will contribute to the increasing use of LGB worldwide.