US005771903A [ii] Patent Number: 5,771,903 [45] Date of Patent: Jun. 30, 1998
4,592,339 6/1986 Kuzmak et al 606/157
5,160,338 11/1992 Vincent 606/228
FOREIGN PATENT DOCUMENTS 906526 2/1982 U.S.S.R 128/898
Primary Examiner—-Jennifer Bahr
Assistant Examiner—Rosiland Kearney
Attorney, Agent, or Firm—Burns, Doane, Swecker &
Mathis, L.L.P.
[57] ABSTRACT
The present invention provides a surgical method for reducing the food intake of a patient by dissecting the lower part of the Esophagus of a patient, applying a band to form a loop around the lower part of the Esophagus and displacing an upper part of the stomach through the loop, thereby forming a small pouch above the band wherein the final position of the band is above the Bursa Omentalis.
9 Claims, 2 Drawing Sheets
1
SURGICAL METHOD FOR REDUCING THE
FOOD INTAKE OF A PATIENT
FIELD OF INVENTION
The invention relates to a surgical method for reducing the 5 food intake of a patient by applying a band around the Esophagus to form a restriction and a small pouch of a portion of the stomach above said restriction. The invention also relates to a band for forming such a restriction and a small pouch and also the use of a band for this purpose. The 10 device is mainly intended for reducing the food intake of a patient for achieving a weight reduction, but it could also be used for other purposes, e g Hernia.
PRIOR ART 15
In the early eighties overweight operations were carried out by placing a band around the stomach, which formed a restriction, thereby preventing food from passing downwards, or more correctly reducing the speed and the amount of food being eaten. After a few years of use of the 20 new surgical method it became evident that it was very difficult to apply the band with an appropriate tightness—if the band was laid to tight around the stomach, patients were affected by vomiting attachs, on the contrary, if the band was too loose, the hole between the upper/lower part of the stomach became too large, resulting in the eating or the weight problems being unaffected. Unfortunately, therefore many operations were a failure.
The solution of this problem was to provide a band having 3Q an inflatable balloon on the inside thereof, like a blood pressure cuff, connected to an injection port so it became possible to change the inside diameter of the band after the operation. In that way, if people were vomiting after the operation it was possible to drain off some fluid through the 3J injection port, thus reducing the opening of the band loop, thereby getting a larger restriction between the upper/lower part of the stomach. On the contrary, if patients did not lose weight, it was possible to inject a certain amount of fluid through the injection port, thereby narrowing the restriction 4Q between the upper/lower part of the stomach, the so called Stoma diameter. This operation was clearly better than the earlier method, but unfortunately this operation was not without problems. Namely, there existed two main difficulties: 45
The loop band appeared to have a tendency to dislocate downwards towards the lower part of the stomach. This was prevented by suturing the lower part of the stomach to the upper part of the stomach, so called tunnelling, to prevent the band from dislocating downwards the major curvature of 50 the stomach. However, sometimes these sutures ruptured, thus negatively affecting a desired long term weight loss.
The second difficulty was that according to my researches, the upper part of the stomach rapidly increased in size, approximately ten times of its original size, with less weight 55 reduction as a consequence.
The most frequently used surgical method during this period was vertical banded gastroplastic (VBG). In this operation a hole through both the back and front wall of the stomach were made with a two row suture instrument. With 60 another suture instrument a four row steel suture was made from these holes up to the Hisca winkle. The smaller upper part of the stomach then functions as a prolongation of the Esophagus. After this step a band was inserted through the hole and applied around the minor side of the stomach, the 65 ends of the band being sutured to each other to form a closed band loop. This operation is not reversible and in a large
2
study made by Mason, United States, including more than a thousand patients, 14% of the patients required a re-operation. The weight reduction was acceptable but by no means satisfactory.
Normally, either the gastric band operation or the vertical band in the gastroplastic operation is performed, the Bursa Omentalis between the lower part of the stomach and the colon is opened. A hole in the Bursa omentalis is made under the stomach. It is then possible to operate from both sides of the stomach, both from the interior and the posterior side. In gastric banding two holes on the minor and major side of the stomach are made. In VBG wherein holes are made through both the back and front walls of the stomach, using a two row suture instrument, also penetration of Bursa Omentalis is required.
The upper part of the stomach wall is adherent to the underlying tissue. There is also a blood vessel—Gastrica Superior—quite high up, close to the stomach and coming up on the minor side of the stomach wall. Close to this blood vessel there is also a fibrotic band, Fascia Tissue—extending from the stomach to the liver. Therefore the band used for the gastric banding is placed just below this blood vessel and said fibrotic band over through the Fundus on the major side of the stomach. Because of the adherence of the stomach wall on the underside, the gastric band can not be localized higher up, when it is tightened around the stomach. Therefore, when this operation is carried out, the stomach portion situated above the band is pulled downwards under the band and the stomach wall under the band is sutured to the stomach wall above the band—thereby providing a tunnel for the band, preventing it from being dislocated downwardly and the same time making the size of the upper part of the stomach, the pouch volume, sufficiently small. If the stomach portion is not pulled downwardly, the pouch will be too large to be effective. But this measure also implies a pretensioning of the stomach portion, which results in said portion rapidly moving upwards, if the sutures rupture, with a too large pouch volume as a consequence.
Normally, according to my studies, the pouch volume initially often will become too large and it is an absolute necessity that the tunnelling sutures do not rupture, for maintaining the pouch volume in the long term. The main problem however, is that the pouch volume, even if the gastric band does not dislocate, rapidly increases in size during the first year after the operation. My studies show that the size of the upper gastric pouch in average increases ten times.
OBJECT OF THE INVENTION
The object of the invention is to propose a new surgical method for providing a restriction in the stomach with the use of a band, which will not dislocate and which method is less complicated, provides for a better long term result than the prior art, and permits that a very small pouch for the food could be shaped in a controlled manner.
This object is reached in accordance with the invention by the features defined in claim 1.
Another object of the invention is to provide a device to be used in association with said surgical method and which permits a controlled adjustment of said restriction as a function of an increase of the pouch volume. Said object is attained by the device defined in claim 7.
PREFERRED EMBODIMENT OF THE
INVENTION
A preferred embodiment of the surgical method and of the device will now be explained by way of example with reference to the annexed drawings, wherein
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