The adjustable gastric band has evolved since its inception and the current technique and type of band have been fairly consistent over the last decade. The goal is to place the band with minimal dissection to create a 30ml pouch when at optimal inflation.
The Angle of His is dissected and separated from the left crus. Then the pars flaccida is opened and a small opening is made just anterior to the right crus as far caudally as possible. A grasper is passed blindly from that opening to the Angle of His and the band is pulled through this space as the grasper is withdrawn.
The band is closed and gastric plication sutures from the fundus to the stomach cephalad to the band are done to prevent prolapse. The tubing is withdrawn and attached to the port which is attached to the deep fascia of the external oblique.
The benefit of this operation is that it is very fast and has low morbidity. The weight loss however is highly variable between patients and depends on frequent visits and adjustments. The long term complications of an implanted device include erosion, prolapse and esophageal dilation.
Schauer PR, Schirmer BD, Brethauer SA. Minimally Invasive Bariatric Surgery
New York, NY: Springer; 2007.
Tamara J. Worlton MD, FACS
Chief, Division of Bariatric and Laparoscopic Surgery
Walter Reed National Military Medical Center