Laparoscopic Adjustable Gastric Banding is a Safe and Effective Treatment for Morbid Obesity, Bakr A. Table 2. Changes in Body Mass Index [BMI(Kg/m2)] and Body weight (Kg) Preoperatively Mean BMI (range) Mean Body Weight (range) 44.2 (41.4-50) 123 (106-151) second postoperative day and the second three months after the procedure. The cause was stomal obstruction con- firmed by gastroscopy and gastrointestinal series. The two patients are scheduled for evaluation for re-operation. One patient asked for removal of the band seven months after the procedure because he felt he had lost enough weight. His BMI reduced from 44.8 to 36.9 Kg/m2. The band was removed laparoscopically, and the patient was discharged from the hospital on the same day. DISCUSSION Dieting and exercise are the safest methods for weight reduction. Yet, these measures are unable to sustain weight loss in morbidly obese patients. On the other hand, surgery has proven to be a successful long-term remedy for morbidly obese and superobese patients. Vertical banded gastroplasty is considered by many as the favorable procedure for weight reduction. It does have its side effects. An obvious disadvantage is that it entails gas- tric stapling and cutting and hence is not completely reversible.2,8,9 The introduction of the silicone gastric band by Kuzmac in 1983 was warmly received by many of those involved in obesity surgery. The reported morbidity, mortality and effi- cacy compares well to vertical banded gastroplasty.7,10 It has the advantage of simplicity as it creates a small gastric pouch and a narrow stoma in one step. Following the suc- cessful use of laparoscopy in many surgical procedures, a few reports showed successful use of laparoscopy in insert- ing the band11-13 and in performing vertical banded gastro- plasty.14,15 In our study, laparoscopic insertion was successful in all attempted patients. The presence of a small sliding hiatus hernia is not a contraindication, but it adds to the difficulty of the procedure. The patients stayed in the hospital for a short mean period of 2.7 days. The cosmetic appearance of postoperative scars was excellent in all patients. Patients started to lose weight rapidly. 3 months (36 patients) 40.4 (36.4-46.8) 113.2 (97-140) 6 months (28 patients) 36.6 (33.6-41.5) 101.8 (91-124) Many of the problems in vertical banded gastroplasty is stoma-related.16 In our study, adjustment of the size of the stoma is easily done as an outpatient procedure. The num- ber of injections needed varies in different patients and it should be individualized. One should not hesitate to deflate the band if the patient starts to suffer from repeat- ed vomiting. The laparoscopic approach yields results that are compa- rable to the open approach for insertion of the adjustable gastric band.7,10 The morbidity rate is lesser, particularly respiratory and wound complications. The cosmetic result is far better than the open approach. Patients return to their full activity earlier. Though the number of patients in this series is small, and the follow-up period is short, we believe, guided by our early results, that the laparoscopic insertion of the gastric band should be the routine way of insertion. The procedure needs fine laparoscopic skills and is best suited for the experienced laparoscopic sur- geon. Patients seem to enjoy all the benefits of laparo- scopic surgery. Proper patient selection is essential as reg- ular follow-up is needed. Despite the potential risk of cholecystitis after weight reduction, we do not feel that prophylactic cholecystectomy should be routinely per- formed in these patients as it adds to the length and risks of an already demanding procedure. Moreover, the port sites are not optimally placed for laparoscopic cholecys- tectomy. Our policy is to remove only symptomatic gall- stones. CONCLUSION Adjustable gastric banding is a recognized successful mean for weight reduction. It is completely reversible as it does not entail gastric stapling, cutting or bypass. In a single step it creates a small gastric pouch and a new "control- lable" stoma. Its application through the laparoscopic approach is feasible and safe. It adds to its advantages and deserves to be the standard technique. 60 JSLS(1998)2:57-61