It is minimal invasive laparoscopic placement It is adjustable It preserves the integrity of the stomach. No cutting or stapling of the stomach is required and there is no bypassing of portions of the stomach or intestines The Lap-BandŽ can be removed laparoscopically at any time if indicated

Morbid obesity is defined by the Metropolitan Live Insurance as an excess weight of 45Kg or more as compared to the ideal body weight (IBW). More than 25% of weight excess is linked with an increased morbidity and mortality.

Selection criteria according to the International Federation for the Surgery of Obesity (IFSO)

BMI >40 Body Mass Index = weight (Kg) ¸ Length2 (m2)

BMI between 30 and 40 in the presence of an associated disease that is treatable by weight loss (hypertension, type II diabetes, osteoarthritis, sleep apnoea)

• Age between 18 and 55
• Stable obesity for more than 5 years
• Failure of conservative treatment
• Absence of endocrine pathology
• No history of alcohol misuse
• Comprehension and compliance by patient
• Acceptable operative risk
• Women must avoid becoming pregnant within two years of the operation.
• Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.
• A long term follow up is required

After one year a loss of 60% of the excess weight can be expected. At 18 months of follow up 70% excess weight loss can be achieved. If the patient is well motivated, the weight loss is usually permanent.

Like any other surgical procedure the LAGB operation carries the risk of complications. Apart from the more general complications such as wound infection, thrombosis and respiratory tract infections, there are specific complications associated with this procedure.

• Splenic injuries have occurred during gastric restriction procedures. Rarely a splenectomy is required.
• Migration of the band and/or access port can occur, resulting in reduced weight loss, weight gain or other complications, and possible re-operation to remove or reposition the device.
• Band erosions into the stomach are extremely rare but have been described.
• Pouch slippage and pouch dilatation have been reported as both an early and a late complication of this procedure.
• The incidence of these problems is much less when an oesophago-gastric banding is done. We adopted the latter technique in 1997.
• Infection can occur at any time in the post operative period and this usually necessitates band removal
• Nausea and vomiting may occur, particularly in the first few days after surgery and when the patient eats more than recommended