Laparoscopic Adjustable Gastric Band:
This restrictive procedure was first performed by Belachew in 1993.
We reduce the size of the stomach by placing an adjustable band around its upper part, in order to create a small gastric pouch of 15-30 ml capacity. This band is connected to a port site that is fixed under the skin of the anterior abdominal wall. The adjustment of the band is done by serum injection inside the port site, upon demand. This will give the patient a feeling of an early satiety.
This restrictive procedure lost its popularity due to the emerging positive results of Laparoscopic Sleeve Gastrectomy. This procedure is still performed at COCP, in rare selected cases.
The majority of our patients still have the Adjustable Band without any complications and in others, the band was removed and replaced by a Sleeve or a Bypass mainly due to weight regain.
Laparoscopic Gastric Plication:
This newly introduced restrictive procedure, also known as Laparoscopic Greater Curvature Plication (LGCP), was first performed by Talebpour in 2009.
It is based on reducing the size of the stomach, by sewing one or more gastric fold starting from the greater curvature of the stomach. This sewing is calibrated over an orogastric tube introduced pre-operatively by the anesthesiologist. This will allow a reduction of 80% of the gastric capacity, will limit the amount of the food that you are eating and provoke an early fullness.
In this technique, no cutting or stapling or resection of the stomach is needed which, in case of failure, will allow any redo surgery.
This procedure is performed almost weekly in our center. The results are still lacking but important weight loss is observed on follow-up.
Laparoscopic Sleeve Gastrectomy:
LSG was first performed by Ren in 1999 and worldwide by Gagner.
At COCP we started adopting this surgery in early 2004 – pioneering in Lebanon.
Sleeve Gastrectomy continues to be the number one procedure at COCP, as it is simultaneously worldwide.
This rising restrictive procedure is based on reducing the size of the stomach, by removing 80-90% of the gastric volume, without any interference with the continuity of the digestive tube.
This technique is also called “Calibrated Vertical Gastrectomy” and will give a “banana” shape to the stomach.
Another important key to success of this intervention is its hormonal component. The removed gastric part is responsible for the secretion of an important hunger stimulating hormone (Grehlin) which explains the decreased appetite even after small meals.
Considered as the pioneers of Laparoscopic Sleeve Gastrectomy in Lebanon, we perform this procedure almost daily in our institution. The mid and long-term results are excellent, with important excess weight loss in almost all of our series as published in IFSO 2011 (Hamburg), IFSO 2012 (Barcelona), IFSO 2013 (Istanbul), 2014 (Montreal), 2015 (Vienna) and 2016 (Gothenburg)