Evolution of a paradigm for laparoscopic adjustable gastric banding.

The first human laparoscopic adjustable gastric banding procedure, using the LAP-BAND device (INAMED Health, Santa Barbara, CA), was performed on September 1, 1993. Because of its minimal invasiveness, reversibility, and adjustability, it is considered a breakthrough in bariatric surgery. Placement of the LAP-BAND is the least invasive operative procedure that can be offered to patients with morbid obesity. The technique has evolved since it was first performed on humans. This evolution mainly concerns the band's position in relation to the gastric wall, which necessitated modifying the posterior dissection for band passage and placement. These technical changes have been aimed at reducing morbidity, especially the major complication, prolapse/slippage or pouch dilatation above the band. Based on personal experience and a review of the literature, the authors describe how the surgical technique has developed since the introduction of the LAP-BAND. The advantages of the LAP-BAND have contributed to its increasing use throughout the world. The authors believe that the approach represents a paradigm shift in bariatric surgery.