Page 26 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):29-31
Comparison between Laparoscopic Gastric Banding and Laparoscopic Sleeve Gastrectomy
Comparison between Laparoscopic Gastric

Banding and Laparoscopic Sleeve Gastrectomy

Jassim A Fakhro
General Surgery Dept., HGH, Hamad Medical City, QATAR

Abstract: Obesity is one of the most diseases that considers as a Surgical Technique
global health problem, with a prevalence of >20% among the adult Laparoscopic Gastric banding (GB) Described in 1993 by Catona,
1,2
population in Western countries and >30% in the USA. The incidence is a surgical option that involves placing a silicone band
of overweight and obesity has increased and it has been identified as an circumferentially around the uppermost aspect of the stomach.
epidemic associated with an increase in the diseases related to obesity, The band creates a small proximal pouch that empties slowly
such as coronary heart disease, type 2 diabetes, hypertension, resulting in early satiety and a decreased appetite. The band is
dyslipidemia, stroke, obstructive sleep apnea, osteoarthritis and attached to an access port that is secured to the rectus muscle
polycystic ovary syndrome. Recent a lot of studies on cancer prevention and can be accessed percutaneously in the office with a needle.
found that increased body weight was associated with an increased Injection of saline into the port results in tightening of the
death rate for all cancers combined and for cancers at multiple specific band. This is performed on an individual basis according to
sites. Thus, high body mass index (BMI) is a risk factor for higher weight loss and appetite. It is the most popular in Europe while
overall mortality. in USA it has been approved by FDA in 2001.
Clinicians all over the world have long been aware of the impact of Sleeve Gastrectomy (SG) described by Hess and Marceau
obesity on health, functioning and well-being. In search of effective since 1988 during the procedure of duodenal switch and since
solutions, morbidly obese patients are increasingly turning to bariatric 1993 by Johnston in an isolated form, consists of vertical gastric
surgery. resection of 80% capacity with exeresis of the fundus and body
There are a lot of bariatric surgeries to achieve the desirable weight of the stomach linearly from the Hiss angle to 3–4 cm from the
loss but the restrictive procedures are more popular as Gastric banding pylorus using Endo GIA staplers, which leaves a gastric residual
(GB). It is characterized by minimal invasivity, total possibility of volume ranging from 50 ml to 200 ml. However, as yet, there is
reversibility and good weight loss at long-term. On the other hand, no agreement on the optimum residual volume.
Sleeve gastrectomy (SG), described by Hess and Marceau since 1988
during the procedure of duodenal switch and since 1993 by Johnston Effect of Surgery on Weight
in an isolated form, is a less common restrictive operation for obesity,
with major invasivity and a longer learning curve than GB. Studies showed that both SG and GB have achieved a good
reduction in the excess weight (Excess weight is defined as the
difference between the actual weight and the ideal weight for
Classification of Obesity
longevity). Initial success in bariatric surgery is defined as a
>50% loss of excess weight, or 50% EWL. In GB %EWL was at
Obesity class BMI (Kg/M ) 1and 3 years, 41.4% and 48%, respectively. While in SG it was
2
Normal 18.5 – 24.9 57.7% at 1 year and 66% at 3 years. Patients with higher BMI
Over weight 25 – 29.9 may require a second-stage operation later, in order to lose the
Morbid obesity I 30.0 – 34.9 rest of their excess weight if their BMI remains >45.
II 35.0 – 39.9
III Over 40 Effect on Co-morbidities
Both of the procedure significantely improve or cured the patient
Materials and Methods co-morbidities and those changed were related to % EWL. In
SG After 12 months, 57.8% of the patients were co-morbidity-
A literature search was performed using search engine Google, free and 31.5% presented only one comorbid condition while in
HighWire Press, Springer Link The following search term was GB. More than 63.8% of patients with sleep apnea improved
used: morbid obesity, laparoscopic gastric banding, sleeve and 46.9% of them stoped using the CPAP. The following table
gastrectomy, outcome, effect on BMI, complication. shows the effect of reducing weight on different diseases.

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