Advantages of the LAP-BAND System vs. the VBG:
There are several complications that are the direct result of the technical nature of the VBG surgery. One complication is the disruption of the staple line that forms the small stomach pouch which can lead to eventual weight regain. Desaive et al. (17) in his series of 838 VBGs noted that staple disruption could occur from I year to 6 years post operatively. Desaive eventually reduced his staple line disruption rate from 32% to 5.4% by reinforcing the four staple lines with a fifth line of non-absorbable, running sutures.
In a study designed to "find the true frequency of staple line disruption" Dr. Svenheden et al. (18) used a standardized radiologic method and found that during the first two years following VBG surgery staple line disruption was as high as 31%. He also found that there was no significance in weight loss between the group with staple line disruption and those with their staple lines intact. This supported his findings that staple line disruption is not (at 2 years post surgery) associated with weight regain and is therefore frequently not detected and reported.
Other complications are the result of the VBG stoma not being able to be adjusted post-operatively. Mason et al. (27) has reported on the complications and weight loss results of various size stomas and the types of materials used. In the VBG, a stoma that is too tight can result in too much stress being placed on the upper pouch leading to dilatation and staple disruption (28), a stoma that is too large will lead to inadequate weight loss.
MacLean et al. (15) notes "Failure of vertical banded gastroplasty in the morbidly obese (body mass index of 40 to 50 Kg/m2) is frequently technical, and a method that eliminates dependence on the integrity of staples should be evaluated."
With the advent of the BioEnterics LAP-BAND Adjustable Gastric Banding (LAGB) System, many of the complications associated with restrictive surgical procedures were eliminated or reduced. Because there is no stapling or opening of the stomach, complications related to staple line leakage and staple disruption are eliminated. In addition, the adjustability of the LAP-BAND System post-operatively is designed to reduce stoma size complications. One surgeon (29) has successfully used the LAP-BAND System to revise failed VBGs. He reported 2-14 month follow-up with satisfactory weight loss with the LAP-BAND System in patients who had stopped losing weight due to pouch dilatation, staple line disruption and stoma dilatation of their VBG procedures. In another case (30) a successful laparoscopic conversion from failed VBG to a LAP-BAND System was achieved.
It has also been demonstrated that although the weight loss from VBG surgery is steeper in the initial months after surgery compared to the LAP-BAND System, at 12 and 18 months the weight loss between the two surgeries is similar (20)(31). Also, the LAP-BAND System patients experience less morbidity and a much shorter hospital stay (30).
The advantages of the LAP-BAND System over the VBG are:
In addition to the above advantages, the benefits of a restrictive procedure over a malabsorptive procedure were retained: