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Indications

  • • As for other bariatric procedures, BMI >40 or BMI >35 with co-morbidity is an indication for surgery [28].
  • • This BMI limit may be reduced by 3 for Asian population as per Asia Pacific surgical criteria; BMI >37 or BMI >32 with co-morbidity [29] Thorough preoperative evaluation should be done as for any other bariatric procedure as per protocols of the institution.

Contraindication

  • • Large hiatus hernia or severe gastro-esophageal reflux is a relative contra- indication.
  • • Patients who cannot follow-up in the clinic for weight loss monitoring and band adjustments must not be offered this procedure.
  • • Patients allergic to silicon.

Surgical Technique

After the plication is done (same technique described as above), we placed an adjustable gastric band.

Adjustable gastric band: Band is then placed using pars flaccida technique with minimal dissection and is locked in proper position. The band is checked for proper functioning after its placement. Band need not be fixed to the stomach. The reservoir port is placed over anterior rectus sheath near the umbilicus.

Post-operative Course

We use the same care process as plication surgery. After discharge, patient is scheduled in clinic 1 week following surgery and thereafter at 1, 3, 6, 9, 12 months. Following which a 6 monthly follow-up is done. Adjustment of the gastric band is started mostly from the third month depending on patient’s satiety, amount of food intake, and weight loss. Full evaluation of patient including upper GI endoscopy is performed after 1 year for surveillance and yearly thereafter.

 
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