Laparoscopic Adjustable Gastric Banding is a Safe and Effective Treatment for Morbid Obesity, Bakr A. All procedures were performed by the same team. The operative layout is shown in Figure 1. The patient is posi- tioned in a head-up position. The procedure was per- formed through a 5-trocar technique (Figure 2). A sixth trocar was used in two patients for traction of enormous greater omentum. The procedure involves gastric partitioning with an inflat- able gastric band (Figures 3 & 4). The band is primarily inserted empty to avoid excessive narrowing of the stoma. Prior to dissection, the proximal gastric pouch is sized 15 ml by a special calibrating tube. A window is opened in the lesser omentum and the retro-gastric space is dissected to accommodate the band. Before closure of the band, the stoma size is adjusted by an electronic device attached to the calibrating tube. The band is fixed in place by a series of inverting non-absorbable sutures. At the completion of the procedure, a specially designed reservoir is inserted deep to the left anterior rectus sheath. Drainage is not needed in this operation. Two patients had symptomatic gallstones, and cholecystectomy was successfully per- formed immediately after band insertion. Patients were allowed oral fluids at the night of the operation and were discharged shortly after the procedure. Weight loss is assessed at monthly intervals for six months and then bimonthly for the same period. At the first visit, a gastric series was performed to assess the size of the stoma and the size of the proximal gastric pouch (Figure 5). If necessary, the stoma is adjusted by injection (or withdrawal) of saline from the reservoir by a special non-coring needle, under fluoroscopic control. Injection is done as an outpatient pro- Figure 2. The port sites. cedure. Injection of 0.4 ml saline narrows the stoma by 0.5 mm, approximately. Injection is indicated when the patient can swallow his regular meal at frequent intervals or if the weight loss is inadequate on repeated visits. Figure 1. Operative Layout. Figure 3. The band with it's reservoir. 58 JSLS (1998)2:57-61