Original article Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity P. E. O'Brien, W. A. Brown, A. Smith, P. J. McMurrick and M. Stephens Monash University Department of Surgery, Alfred Hospital, Melbourne 3181, Victoria, Australia Correspondence to: Professor P. E. O'Brien Background: Surgical control of morbid obesity should bene®t from a minimally invasive approach and the ability to adjust the degree of gastric restriction. Methods: The Lap-Band adjustable gastric banding system was evaluated prospectively in a consecutive series of 302 patients, and data on perioperative outcome and weight loss pattern at up to 4 years of follow-up are presented. Some 302 patients 89 per cent women; mean age 39 years, mean weight 124 kg) were entered into the study. Laparoscopic placement was used in 277 patients. Previous gastric stapling surgery was the principal reason for an elective open approach. Results: The incidence of signi®cant early complications was 4 per cent and included two perforations of the stomach after open placement. The mean length of stay after laparoscopic placement was 3á9 days and only one complication infected reservoir site) occurred in these patients. The principal late com- plication of prolapse of the stomach through the band occurred in 27 patients 9 per cent). Signi®cant modi®cation of technique and patient care has enabled reduction of this complication in the latter part of the series. Means.d.) excess weight loss was 51á017) per cent at 12 months n  120), 58á320) per cent at 24 months n  43), 61á62) per cent at 36 months n  25) and 68á221) per cent at 48 months n  12). Conclusion: The Lap-Band is an effective method for achieving good weight loss in the morbidly obese at up to 4 years of follow-up. Laparoscopic placement has been associated with a short length of stay and a low frequency of complications. The ability to adjust the setting of the device to achieve different degrees of gastric restriction has enabled progressive weight loss throughout the period of study. Paper accepted 23 July 1998 British Journal of Surgery 1999, 86, 113±118 Introduction Obesity is one of the most common chronic illnesses in the Western world with a frequency of 10±15 per cent. It causes or exacerbates many diseases and is associated with major physical and psychosocial disabilities 1,2 . It is esti- mated to represent more than 5 per cent of total health- carecostsintheUSA 3 .Thesolutiontothisproblemisnot yet evident. Optimal programmes of diet and exercise, augmented by drug therapy and behavioural modi®cation, can be expected to provide a sustained weight reduction of up to 10 kg if therapy continues inde®nitely 4 . For most obese people this is either insuf®cient or unsustainable. Surgical methods for weight control, which have centred mainly on various forms of gastric stapling, can achieve major weight reduction over a prolonged period for a majority of patients treated 5±8 . However, the commonly used techniques have not become the widely accepted treatment for reasons of invasiveness, irrevers- ibility and lack of long-term control. These procedures require laparotomy and major surgery. They carry risks of major morbidity and even death. They create important changes to the normal anatomy which can be restored only with further major surgery. The inability to modify the degree of gastric restriction after gastric stapling has been completed is perhaps the most signi®cant frustration for the treating physician. The settings established at operation have to be correct for day 1 after operation and for the years after operation. Fre- quently the setting is initially too tight, vomiting is com- mon and compromised eating behaviour occurs. More frequently, there is later enlargement of the stoma, de- hiscence of the staple line or expansion of the proximal stomach, and reduced effectiveness ensues. The challenge Ó 1999 Blackwell Science Ltd British Journal of Surgery 1999, 85, 113±118 113