JSLS Laparoscopic Adjustable Gastric Banding is a Safe and Effective Treatment for Morbid Obesity Ashraf Aly Mohammad Bakr, MD1, Tawfik Fahim, MD2 ABSTRACT Objective: Surgery has been recognized as an effective long-term treatment for morbid obesity. The purpose of this study is to present our experience of laparoscopic adjustable gastric banding (LAGB) as a safe and effective treatment for morbid obesity. Methods and Procedures: Over eight months, 39mor- bidly obese patients, having a Body Mass Index (BMI)>40 kg/m2, were included in this study. Conservative measures failed to maintain weight loss in all patients. The procedure is performed through a 5-trocar technique. The procedure involves gastric partitioning and stoma formation by an inflatable band. The stoma can be adjusted by injection of saline in the band reservoir. Results: The mean age of the patients was 31.3 years. The mean BMI was 44.2 Kg/m2. All procedures were complet- ed laparoscopically. The mean hospital stay was 2.7 days. The morbidity rate was 15.32%. Patients were followed up for a mean period of 6.7 months. The mean BMI after six months (in 28 patients) was 36.6 Kg/m2. Conclusion: Laparoscopic insertion of the adjustable gas- tric banding is a safe and effective method for the treatment of morbid obesity and should be the standard way of band insertion. Key Words: Morbid obesity, Gastric band, Laparoscopy. 1Assistant Professor of Surgery, Faculty of Medicine, University of Cairo. 2FRCS (England, Edinburgh), Professor of Surgery, Faculty of Medicine, University of Ain Shams. Address reprint request to: Dr Ashraf Bakr, 98 Tahrir Street, Suite 609, Dokki, Giza, Egypt. INTRODUCTION Obesity is associated with a great variety of diseases, most notably affecting the cardiovascular system.1 Various indices are used to quantify obesity—the most commonly used one is the Body Mass Index (BMI). It calculates the body weight in kilograms in relation to the height in meters squared [i.e., BMI = Weight (kg) / Height (m2)]. The ideal body weight is represented by BMI of 20-25, while a BMI of > 40kg/m2 points to a morbidly obese person. Medical treatment in the form of diet and exercise fails to produce long-term loss of weight in some 90% of morbidly obese patients. On the other hand, various surgical proce- dures designed to treat morbid obesity showed a successful long-term outcome.2-5 The silicone gastric band was introduced by Kuzmac6,7 in 1983 and in several reports showed to be as effective as the other procedures entailing gastric partitioning and stoma for- mation (such as Vertical banded gastroplasty) or gastric bypass, with fewer side effects.8 The introduction of laparoscopy revolutionized surgical practice, and in morbidly obese patients laparoscopic pro- cedures, such as cholecystectomy, proved to be far lesscom- plicating than conventional surgery. Patients enjoy a short- er hospital stay, lesser incidence of wound sepsis and fewer incisional hernias. The aim of this work is to present our experience with the laparoscopic application of adjustable gastric band and its outcome. PATIENTS AND METHODS This study involved 39 patients (26 females, 13 males)—all were morbidly obese, with BMI > 40 kg/m2. Conventional dieting and exercise failed to maintain weight loss in all patients. Hormonal assays were performed to exclude endocrine disturbances in suspected cases. All patients were assessed by a psychiatrist and only those approved were offered the procedure. Patients were informed about the nature and the hazards of the procedure. They were told about the postoperative course and the need for regular fol- low up. JSLS (1998)2:57-61 57