History of Lap-Band: from dream to reality.
BACKGROUND
Laparoscopy in severely obese patients is a surgical challenge due to the deep operative field, massive visceral fat, hypertrophic and steatotic liver and inadequate instrumentation. However, performing bariatric surgery by laparoscopy permits a minimally invasive procedure in patients who are usually considered high risk because of their morbid obesity. The challenge was to overcome technical difficulties of laparoscopy in the morbidly obese.


METHODS
We needed to develop a new surgical protocol for the gastric approach in severely obese patients. The existing silicone band could not be used for laparoscopy, and a new prototype of the silicone band for laparoscopic use was designed. Because of ethical reasons, we began this work on the animal model. In an animal lab program using pigs, we refined the surgical technique of the laparoscopic approach. A new design of the adjustable silicone band for laparoscopic use was developed.


RESULTS
After a 1-year animal lab program and approval by the ethics committee, we performed our first human laparoscopic adjustable gastric banding on September 1st, 1993.


CONCLUSIONS
The development of the Lap-Band from concept to animal lab, ending in clinical application, has been an advance in bariatric surgery.
Belachew
M
M
Service de Chirurge Universitaire, CHH 2, Rue des Trois Ponts, 4500 Huy, Belgium. mitiku.belachew@ping.be
Legrand
M J
MJ
Vincent
V
V
D000818:Animals; D015391:Gastroplasty / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D023421:Models, Animal; D009767:Obesity, Morbid / Q000601:surgery; D019736:Prostheses and Implants; D013552:Swine