US20040153106A1 - Gastric band - Google Patents

Abstract

A gastric band of a belt type is presented for attaching around a circumference of a patient's stomach, so as to define the diameter of the stomach opening. The band comprises outer and inner surfaces, wherein the inner surface engages the stomach, and at least the outer surface is formed by an elongated member substantially non-extendable along a longitudinal axis thereof. A through-going opening is made in the elongated member and is located so as to define an end portion of the band having a predetermined length. An opposite end portion of the band is shaped so as to be insertable into the through-going opening for adjusting a desired inner diameter of the band in its closed operating position and fastening the opposite end portion to the outer surface of the band.

Description

FIELD OF THE INVENTION
• This invention relates to a gastric banding device that encircles a portion of the stomach to form a stoma opening of reduced diameter.[0001]
BACKGROUND OF THE INVENTION
• Morbid obesity is associated with medical risks in terms of the development of additional diseases such as diabetes, hypertension, cardiac insufficiency and other socio-psychological problems, overall reducing life expectancy. Dietary management, psychiatric or dietary regiments are the first choice for treating morbid obesity, but as they depend on the goodwill of the patient, especially in the long run, these approaches often fail.[0002]
• Various surgical approaches have been developed and used for treating morbid obesity. These include gastric bypasses, small bowel bypasses and stapling of portions of the stomach. The stapling techniques include horizontal and vertical stapling for reducing the volume of the stomach, as well as narrowing the stoma opening thus controlling the food intake of the stomach. However the latter approach, stapling, may not bring the desired results due to the fact that the staples frequently open or tend to cause perforations. Furthermore the stomach opening formed by staples widens over time, thus the effect is reduced or even eliminated.[0003]
• A different approach to the problem specified above is described in U.S. Pat. No. 4,416,267, which discloses a method for treating obesity by placing an inflatable balloon into the stomach. Such a device displaces volume inside the stomach, thereby reducing the effective free volume of the gastric portion causing the individual to feel no need for additional food intake. The balloon is inflated in the stomach to a predetermined volume and is left there for a certain period of time after which it is easily removed. However, this procedure although being physically easy to implement and basically being non-surgical, may lead to harmful results. The inflated balloon in the stomach is in constant contact with gastric mucous, and such contact for an extended period of time may give rise to gastric ulcers and intestinal blockage.[0004]
• Recently, another approach has been developed based on placing a physical means (i.e. a gastric band) outside the stomach. A gastric band is placed around the upper part of the stomach, thereby creating an altered stomach opening of a reduced diameter, resulting in the restriction of food intake into the digestive portion of the stomach. Such a gastric-banding technique is simple as compared to the above-mentioned balloon-based technique. However, this band has no means for adjusting its diameter to obtain the optimal diameter of the stomach opening.[0005]
• Adjustable gastric bands have been developed, and disclosed for example in U.S. Pat. No. 4,592,339, as well as in “A Gastric Band with Adjustable Inner Diameter for Obesity Surgery”, P. Forsell et al., Obes Surg., 1993, No. 3, pp. 303-306. According to this technique, the diameter of a belt-like band, when in a closed position thereof, may be adjusted. For this purpose, the band includes an inflatable portion in its interior part. Controllable inflating and deflating of this portion alters the stomach opening. Although this gastric band can retain the predetermined diameter of the stomach opening, obtaining of the proper opening is somewhat problematic.[0006]
• U.S. Pat. No. 4,696,288 discloses a calibrating apparatus for using with, a gastric band for controlling the diameter of the stomach opening by regulating the band's diameter. Such a gastric band is typically mounted with a laproscopic technique, disclosed for example in U.S. Pat. No. 5,226,429.[0007]
SUMMARY OF THE INVENTION
• It is a main object of the present invention to provide a gastric band of a belt type, which can be attached to a patient's stomach in a safe manner and without damaging the stomach circumference.[0008]
• It is a further object of the present invention to provide such a band which can be easily mounted on the stomach utilizing a laproscopic technique.[0009]
• It is a still further object of the present invention to provide such a band that is easily enables its facile detectable by any suitable imaging means, thereby facilitating access to the band when additional surgical/laproscopic intervention is desired.[0010]
• There is thus provided according to one aspect of the present invention, a gastric band for attaching around a circumference of a patient's stomach so as to define the diameter of the stomach opening, the band comprising:[0011]
• (a) outer and inner surfaces, wherein the inner surface engages the stomach, and at least the outer surface is formed by an elongated member substantially non-extendable along a longitudinal axis thereof;[0012]
• (b) a through-going opening made in said member and located so as to define an end portion of the band having a predetermined length; and[0013]
• (c) an opposite end portion of the band shaped so as to be insertable into said through-going opening for adjusting a desired inner diameter of the band in its closed operating position and fastening the opposite end portion to the outer surface of the band.[0014]
• The gastric band is of a belt type, and also comprises a suitable fastening means, which may utilize a required number of stitches or the provision of bolt-and-nut arrangements on the band. The fastening means may also be in the form of teeth-like edges of the opposite end portion and a correspondingly shaped through-going opening.[0015]
• The outer and inner surface may be formed either of the same material, or of different materials, provided that the material of the outer surface is substantially not-extendable.[0016]
• Preferably, at least the outer surface of the band is made of poly-tetra-fluoro-ethylene, known as Gortex. The material of the inner surface of the band engaging the stomach may be silicone. The band, when in the operation position thereof is such that its inner surface engaging the stomach has a substantially circular shape.[0017]
• The predetermined length of the end portion is such as to enable the detection of the gastric band by a laproscopic inspection tool.[0018]
• According to another aspect of the present invention, there is provided a system for laproscipically attaching a gastric band around a patient's stomach so as to define a certain diameter of the stomach opening,[0019]
• the system comprising a calibration device which is insertable into the stomach at a predetermined depth and comprises:[0020]
• an upper portion having variable volume, and[0021]
• a lower projection-like portion having a diameter substantially equal to said certain diameter of the stomach opening to be defined by the band, the location of said projection-like portion when in the inserted position of the calibration device defining the location of the band with respect to the stomach;[0022]
• said band comprising:[0023]
• outer and inner surfaces, wherein the inner surface engages the stomach, and at least the outer surface is formed by an elongated member substantially non-extendable along a longitudinal axis thereof;[0024]
• a through-going opening made in said member and located so as to define an end portion of the band having a predetermined length; and[0025]
• an opposite end portion of the band shaped so as to be insertable into said through-going opening for adjusting a desired inner diameter of the band in its closed operating position and fastening the opposite end portion to the outer surface of the band.[0026]
BRIEF DESCRIPTION OF THE DRAWINGS
• In order to understand the invention and to see how it may be carried out in practice, a preferred embodiment will now be described, by way of non-limiting example only, with reference to the accompanying drawings, in which:[0027]
• FIGS. 1[0028]aand1bare schematic illustrations of a gastric band in its open and closed positions, respectively, constructed according to one embodiment of the invention;
• FIG. 2 schematically illustrates the band of FIGS. 1[0029]aand1bin its operation position being attached to the patient's stomach;
• FIGS. 3[0030]aand3bare schematic illustrations of a gastric band in its open and closed positions, respectively, constructed according to another embodiment of the invention;
• FIGS. 4[0031]aand4bare schematic illustrations of a gastric band in its open and closed positions, respectively, constructed according to yet another embodiment of the invention;
• FIGS. 5[0032]aand5bare schematic illustrations of a gastric band in its open and closed positions, respectively, constructed according to yet another embodiment of the invention;
• FIGS. 6[0033]aand6bschematically illustrate two steps of a calibration procedure carried out prior to mounting the band on the stomach; and
• FIGS. 7[0034]ato7fillustrates five sequential steps, respectively, of mounting the band of FIGS. 3a-3bonto the patient's stomach.
DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT
• Referring to FIGS. 1[0035]aand1bthere is illustrated a gastric band, generally designated1, constructed according to one embodiment of the invention. The band is typically an elongated strap having two opposite end portions1aand1b.The portion1bis substantially cone shaped, while the end portion1ais formed with a through-going, substantially elliptically-shapedopening4 displaced from the corresponding butt-end of theband1 by a certain length L₀, the purpose of which will be described further below. For example, the band's dimensions may be as follows:
• 1) the length L[0036]₁of the entire band is about 15 cm;
• 2) the length L[0037]₀is about 3 cm;
• 3) the width h[0038]₀of the band is 2 cm;
• 4) the thickness h[0039]₁of the band is 2 mm; and
• 5) the long axis L[0040]₂of theopening4 is about 1-7 mm.
• As clearly seen in FIG. 1[0041]b,theband1 has outer and inner surfaces2aand2b,respectively. To attach theband1 around a stomach (not shown here), the cone shaped end portion1bpasses through theopening4, and is fastened along a corresponding location on the band by a suitable fastening means, for example by stitches6. Thereafter, the free part of the end portion1bis cut off by any suitable means, as shown in a dashed line. The opposite end portion1a,whilst being optionally partly stitched to theband1, extends away therefrom. Theband1 is made of a polymer material, which is substantially non-extendable along its longitudinal axis. For example, poly-tetra-fluoro-ethylene (i.e. Gortex) can be used for manufacturing theband1.
• Turning now to FIG. 2, there is illustrated that, when in the operative position of the[0042]band1 being attached around astomach10, the free end portion1aprotrudes from the band. It will be readily understood that such a protrusion would be easily detected by any suitable imaging means. This is a very important feature facilitating the access to the band when additional surgical/laproscopic intervention is desired
• As further seen in FIG. 2, the[0043]band1 actually defines two portions10aand10bof thestomach10, and defines the diameter of a so-called stomach opening (not seen here) underneath theband1. The portions10aand10bare fastened to each other bystitches12 or the like within the vicinity of theband1, thereby fixing its relative location on the stomach. It should be noted that stitches6, as well as thestitches12, may be replaced by any other suitable fastening means.
• Reference is made to FIGS. 3[0044]aand3b,illustrating agastric band14 in its opened and closed positions, respectively. Theband14 has somewhat different construction as compared to theband1. To facilitate understanding, same reference numbers are used for identifying those components, which are identical in thebands1 and14. Here, at least one so-called “bolt-and-nut” arrangement is provided serving as the fastening means. To this end, as shown in the figures in a self-explanatory manner, spaced-apart mushroom-like bolts, generally at16, project upwardly from the upper surface2a.Consequently, holes18 (four in the present example) are aligned along the longitudinal axis of the band in a spaced-apart parallel relationship. The diameter of thehole18 corresponds to that of the head portion of the mushroom-like bolt16 to put the bolt-and-nut arrangement into its engaged position, thereby closing the band.
• In this specific example, the[0045]bolts16 project from a plate-like support20, forming together an integral assembly, generally designated22. Theassembly22 is attached to the upper surface2aof theband14 by stamping. The entire band, except for theassembly22, may be made of a polymer material like Gortex, while theassembly22 may be made of a substantially rigid silicone. The bolts16 (and consequently two locally adjacent holes18) are spaced from each other by the length L₄of about 7 mm, the dimensions of theplate20 being as follows: the length L₃=2 cm, and the width h₃=12 mm. As shown in FIG. 3b,after closing the band on the patient's stomach, two stitches24 (or the like) are provided to ensure the fixed diameter of the band, and thereby of the stomach opening. Similarly to the previously described embodiments, the corresponding part of the end portion1bis cut off, while the opposite part1aprotrudes from the band to be detectable.
• FIGS. 4[0046]aand4billustrate a gastric band, generally at26, according to yet another embodiment of the invention. Similarly, same reference numbers are used for identifying those components, which are identical in thebands1,14 and26. Theband26, in distinction to thebands1 and14, has its inner surface2bformed of a relatively flexible material relative to that of the outer surface. For example, this may be implemented by coating a center part of the inner surface of theband26 with silicone. As for the outer surface2aof theband26, as well as the inner surface thereof within the end portions, they are made of a substantially non-extendable material. The end portion1ashould be made of such a non-extendable material which is not too rigid in order not to harm the stomach, e.g. Gortex.
• FIGS. 5[0047]aand5billustrate yet another construction of agastric band27 using the same reference numbers for identifying the common elements in thebands1,14,26 and27. In theband27, similar to theband26, the center part of its inner surface is formed with a substantially flexible material, e.g. flexible silicone, while the end portions are made of a non-extendable material. As for the fastening means, in theband27 the end portion1bis formed with teeth-like edges16′. Consequently, a through-goingopening4′ is shaped in a manner to define aslot18′ allowing a forward movement of the portion1bthrough theopening4′, but preventing its sliding back out of theopening4′ in the operating (closed) position of theband27. To this end, the center part of the outer surface2a,as well as the end portion1b,are made of a substantially rigid material, e.g. rigid silicone. As indicated above, the opposite end portion1ashould be made of a substantially flexible material.
• Reference is now made to FIGS. 6[0048]aand6billustrating two steps of a typically performed calibration stage for determining the desired diameter of the stomach opening and defining its location to mount a gastric band there. To this end, a calibrating device, generally designated28, is used. The construction and operation of such a calibration device are known per se, and therefore need not be described in detail, except to note the following. Thedevice28 comprises an upper, balloon-like portion28aassociated with a suitable pump, which is not specifically shown, and alower projection28bbhaving a substantially circular cross-section of the desired diameter D₀.
• Upon inserting the[0049]device28 inside thestomach10 through astomach inlet29, the balloon-like portion28ais inflated up to the volume V₁corresponding to the diameter D₁of the portion28a,so as to substantially engage the inner circumference of thestomach10. This maximum diameter D₁of the portion28ais determined in accordance with the inflating pressure.
• Thereafter, the device is partially deflated to such a volume V[0050]₂that corresponds to the diameter D₂of the portion28a,and pulled upwardly up to theinlet29. Such a position of thedevice28 having the known diameter D₂of its balloon-like portion28aactually allows for locating the projection28b,thereby defining the location for mounting the gastric band. The calibratingdevice28 also comprises apipe30 installed thereinside, serving for aspirating the stomach contents and checking whether the mounting of the band caused any damage to the stomach itself, as will be described more specifically further below with reference to FIG. 7f.
• Referring to FIGS. 7[0051]ato7f,there are illustrated the main operational steps for laproscopic mounting of the gastric band, for example constructed as described above with reference to FIGS. 3aand3b,on the patient's stomach. As indicated above, the position of the projection28bdefines the exact location for mounting the band. Hence, it defines the convenient locations for cuttings32aand32bto be made in thestomach connecting tissue32 at opposite sides of thestomach10. An articulated grippingdevice34 is typically used for mounting the gastric band on thestomach10. FIG. 7aillustrates that the articulated grippingdevice34 is sequentially pushed through the openings32band32a,to clamp the cone shaped end portion1bof theband14. Then, by pulling thedevice34, the band is threaded through the openings32aand32b,thereby engaging the back-side of the stomach (FIG. 7b).
• This having been done, a pair of[0052]gripping devices36 and37 are used for supporting the end portion1aof the band, while thedevice34 passes through theopening4 and proceeds towards the cone shaped portion1b(FIG. 7c). As shown in FIGS. 7dand7e,by manipulating thegripping devices36 and37, the cone shaped end portion1bis threaded through theopening4 and pulled to close the band in a manner described above with reference to FIGS. 3aand3b.The closed operating position of the band is illustrated in FIG. 7f.
• After completing the mounting of the[0053]gastric band14, a pair ofstitches24 are provided and, optionally, depending on the desired diameter, the end portion1bis partly cut off. To check whether the entire operation did not damage the stomach and did not completely block the stomach opening, the following procedure is carried out. After the total deflation of the balloon28a(through a suitable pump-valve assembly38) and pulling of the calibratingdevice28 upwardly towards the upper part of the paunch, a colored liquid is injected into thepipe30 through anupper opening39 of thedevice28. It will be readily understood that the non-passage of this liquid into the stomach through the lower end of thepipe30 indicates of the blockage of the stomach opening. Likewise, any dripping of the colored liquid out of the stomach would indicate of the dangerous condition of stomach perforation, which should immediately be treated.
• Those skilled in the art will readily appreciate that various modifications and changes can be applied to the invention as hereinbefore exemplified without departing from its scope defined in and by the appended claims. For example, the gastric band may have any appropriate dimensions, providing it is capable of providing the desired diameter of the stomach opening and its free end portion is detectable by a suitable imaging system.[0054]

Claims (15)

1. A gastric band for attaching around a circumference of a patient's stomach so as to define the diameter of the stomach opening, the band comprising:

(a) outer and inner surfaces, wherein the inner surface engages the stomach, and at least the outer surface is formed by an elongated member substantially non-extendable along a longitudinal axis thereof;

(b) a through-going opening made in said member and located so as to define an end portion of the band having a predetermined length; and

(c) an opposite end portion of the band shaped so as to be insertable into said through-going opening for adjusting a desired inner diameter of the band in its closed operating position and fastening the opposite end portion to the outer surface of the band.

2. The gastric band according toclaim 1, and also comprising a fastening means for fastening said opposite end portion of the band when in said operating position thereof

3. The gastric band according toclaim 1, wherein said fastening utilizes at least two stitches applied to the band.

4. The gastric band according toclaim 2, wherein said fastening means comprises at least one mushroom-like projection located on the outer surface of the band, and at least one through-going hole for receiving said at least one mushroom-like projection, when in the operating position of the band.

5. The gastric band according toclaim 2, wherein said fastening means comprises a plurality of teeth extending along opposite edges of said opposite end portion, said opening being shaped in a manner to define a slot for receiving the teeth-like opposite end portion so as to allow its movement in a forward direction through said opening and preventing its sliding in a reverse direction.

6. The gastric band according toclaim 1, wherein said end portion is made of a substantially flexible material.

7. The gastric band according toclaim 1, wherein said outer and inner surfaces are formed of the same material.

8. The gastric band according toclaim 1, wherein said outer and inner surface are formed of different first and second materials, respectively.

9. The gastric band according toclaim 7, wherein said second material is substantially flexible.

10. The gastric band according toclaim 8, wherein said second material comprises silicone.

11. The gastric band according toclaim 7, wherein said first material comprises poly-tetra-fluoro-ethylene.

12. The gastric band according toclaim 4, wherein the material of said outer and inner surfaces comprises poly-tetra-fluoro-ethylene.

13. The gastric band according toclaim 1, wherein said inner surface engaging the stomach has substantially circular shape when in the operating position of the band.

14. The gastric band according toclaim 1, wherein said predetermined length of the end portion is such as to enable the detection of the gastric band by a laproscopic inspection tool.

15. A system for laproscopically attaching a gastric band around a patient's stomach so as to define a certain diameter of the stomach opening, the system comprising a calibration device which is insertable into the stomach at a predetermined depth and a pair of articulated gripping devices, wherein the calibration device comprises:

an upper portion having variable volume, and

a lower projection-like portion having a diameter substantially equal to said certain diameter of the stomach opening to be defined by the band, the location of said projection-like portion when in the inserted position of the calibration device defining the location of the band with respect to the stomach;

said band comprising:

outer and inner surfaces, wherein the inner surface engages the stomach, and at least the outer surface is formed by an elongated member substantially non-extendable along a longitudinal axis thereof;

a through-going opening made in said member and located so as to define an end portion of the band having a predetermined length; and

an opposite end portion of the band shaped so as to be insertable into sad through-going opening for adjusting a desired inner diameter of the band in its closed operating position and fastening the opposite end portion to the outer surface of the band.

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