الفهرس 
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Abstract
Obesity is simply defined as ”excessive amount of body fat with increase in weight inadequate with body height ” and should be considered a chronic disease, as it has definite mortality and morbidity.
The most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in kilograms divided by the square of his or her height in meters. Morbid obesity is having a BMI greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with concomitant obesity-related morbidity.
The incidence of obesity is steadily rising. Morbid obesity is associated with a large number of problems. Several of these problems are underlying causes for the earlier mortality associated with obesity and include; coronary artery disease, hypertension, impaired cardiac function, adult onset type 2 diabetes mellitus, venous stasis and hypercoagulability leading to an increased risk of pulmonary embolism, increased risk of uterine, breast and colon cancer.
Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with a BMI >27 kg/m2 who also have concomitant obesity-related diseases and for whom dietary and physical activity therapy has not been successful.
However, because the only effective treatment for morbid obesity is bariatric surgery, these are the initial steps to be taken in preparation for the more definitive treatment. Bariatric surgery offers the only means of delivering sustained weight loss.
Bariatric surgical techniques are divided into two groups: malabsorptive and restrictive procedures. In general, restrictive procedures are simpler to perform and are accompanied by less procedural complications than malabsorptive procedures.
The original purely malabsorptive procedures such as jejuno-ileal bypass are no longer performed due to their unacceptably high late complication rate. They have been replaced by restrictive or combined operations. Open surgery has largely been replaced by a laparoscopic approach. The most common operations performed are: vertical banded gastroplasty, adjustable gastric banding, biliopancreatic diversion and Roux-en-Y gastric bypass.
It’s clear that LAGB is the best procedure for people who want to have a reversible operation.
LAGB surgery provides a safe, effective and minimally invasive procedure, which enables major and durable weight loss in association with improvement or resolution of a broad range of serious health problems. Its unique characteristics of adjustability, and reversibility are important providing great flexibility for the patient both now and into the future.
This procedure is becoming increasingly popular in the United States. The band is placed laparoscopically around the upper stomach, allowing the formation of a small gastric pouch and stoma. There is no resection or stapling of the stomach itself, and no gastric or intestinal bypass.
In general, gastric banding is indicated for people for whom all of the following apply:
• Body Mass Index above 40, or those who are 100 pounds (7 stone/45 kilograms) or more over their estimated ideal weight, according to the National Institutes of Health, [4] or those between 30 to 40 with co-morbidities that may improve with weight loss (type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructivesleep apnea.)
• Age between 18 and 55 years (although there are doctors who will work outside these ages, some as young as 12)
• Failure of medically supervised dietary therapy (for about 6 months).
• History of obesity (up to 5 years).
• Comprehension of the risks and benefits of the procedure and willingness to comply with the substantial lifelong dietary restrictions required for long term success.
Gastric banding is usually not recommended for people with any of the following:
• If the surgery or treatment represents an unreasonable risk to the patient
• Untreated endocrine diseases such as hypothyroidism
• Inflammatory diseases of the gastrointestinal tract such as ulcers, esophagitis or Crohn’s disease.
• Severe cardiopulmonary diseases or other conditions which may make them poor surgical candidates in general.
• An allergic reaction to materials contained in the band or who have exhibited a pain intolerance to implanted devices
• Dependency on alcohol or drugs
• People with severe learning or cognitive disabilities or emotionally unstable people
Advantages of laparoscopic gastric banding compared with open gastric banding or RYGB include possible reductions in wound complications, incisional hernias, respiratory complications because of improved postoperative ventilation and earlier mobilization, shorter recovery time, and shorter hospital stay. Other advantages of LAGB include the maintenance of gastric integrity, thus, the possibility of total reversibility of the operation and the potential for readjustment of the band to address either persistent postoperative vomiting or failed weight loss if needed potential disadvantages to laparoscopic LAGB include the occurrence of significant complications and adverse events, sometimes necessitating removal of the device.
A commonly reported occurrence for banded patients is regurgitation of non-acidic swallowed food from the upper pouch, commonly known as Productive Burping, other complications include : Ulceration, Gastritis, Erosion, migration through the stomach wall, Slippage, Malposition, Internal bleeding, Infection.
Digestive Complications include
Nausea and/or vomiting, Gastroesophageal reflux, Stoma, obstruction, Dysphagia, Diarrhea, Constipation.