Obesity is dramatically increasing in incidence in the Western world. In the UK 17% of the population is obese. The annual healthcare costs arising directly from obesity are at least £2bn in the UK and £45bn in the USA. Long term loss of weight is usually not achieved by dietary measures alone, nor by behavioural therapy. Successive failure to lose weight causes enormous psychological problems. A surgical solution is therefore indicated.

Gastric restrictive surgery has evolved over the past decade as the treatment of choice for morbid obesity. The LAP-BAND® Adjustable Gastric Banding System is designed to induce weight loss in obese patients by limiting food consumption (Bioenterics).

Laparoscopic placement of this band combines the advantage of a non-invasive gastroplasty with the advantages of keyhole surgery. The LAP-BAND® divides the stomach into a small proximal pouch and a large distal pouch.

The inner surface of the band is inflatable and connected by a tubing to an access port which is implanted in the abdominal wall. This permits post operative percutaneous stoma size adjustment. The small proximal pouch acts as the new stomach and a feeling of satiety is reached after ingestion of only a small amount of food (15ml).

The major prerequisite of satisfactory performance of this technically demanding procedure is laparoscopic experience.