The history and role of gastric banding.

Gastric banding has emerged in the development of bariatric surgery as an important therapeutic option for morbidly obese patients. Following the major pioneering milestones of Wilkinson and Peloso, who placed a nonadjustable band around the upper part of a patient's stomach in 1978, and Hallberg and Forsell, as well as Kuzmak, who worked on separate continents to develop the clinical application of adjustable gastric bands in the early 1980s, banding entered into widespread use in the mid 1990s, when the innovation of the laparoscopic technique made it possible to insert adjustable bands without open surgery. Today, several institutions have reported long-term (> or =5-year) results with laparoscopic adjustable gastric banding (LAGB). With a small number of exceptions, LAGB efficacy data range from satisfactory to excellent, with some institutions noting annual reoperation rates in the vicinity of 5%, and quality of life scores using the Bariatric Analysis and Reporting Outcome System in the good-to-excellent range in up to 70% of patients. These outcomes, coupled with the fact that LAGB has the best record of safety among the bariatric operations, is reversible, and can be performed at a relatively low cost, have established LAGB as an important tool in the long-term management of morbid obesity.