Overview of the Gastric Banding Procedure

Laparoscopic Adjustable Gastric Banding (LAGB) is purely restrictive weight loss surgery. Restrictive forms of weight loss surgery such as LAGB promote weight loss by limiting food intake and promoting a feeling of fullness (satiety) after meals. The LAGB surgery was developed for bariatric patients who wanted a safer, less complex alternative to gastric bypass surgery.

How it Works

During laparoscopic adjustable gastric banding surgery, two medical devices are implanted into the body. A silicone band is placed around the upper stomach and an injection port is attached to the abdominal wall under the skin. The port is connected to the gastric band with tubing. The silicone band is lined with an inflatable balloon that can be filled with saline via the access port in order to adjust the size of the stomach opening. Adding fluid tightens the band and increases weight loss, while removing liquid loosens the band and reduces weight loss.

Diagram of the Lap Band Procedure
Adjustable gastric banding is a restrictive type of weight loss surgery.

Most patients are able to have the surgery performed laparoscopically. Laparoscopic surgery is a minimally invasive surgery technique that utilizes special tools inserted through small incisions, rather than cutting open the abdominal wall as in more invasive open surgery. By performing the adjustable gastric banding surgery laparoscopically, patients heal faster, recover quicker, experience less pain, and get released from the hospital sooner.

Laparoscopic adjustable gastric banding surgery is preferred by many because it is reversible, adjustable, and poses less risk than gastric bypass surgery. It does not involve stomach stapling, does not bypass the pyloric valve (the normal stomach outlet that controls the movement of food from the stomach to the intestines), and does not involve cutting and rerouting of the intestine. It does not cause malnutrition as with malabsorptive procedures and does not cause dumping syndrome as with gastric bypass surgery.

Advantages of Gastric Banding

  • Adjustable without additional surgery (fills via access port)
  • Reversible (if gastric band removed stomach returns to normal)
  • Laparoscopic placement (minimally invasive surgery)
  • Stomach is not cut, stapled and reshaped
  • Pyloric valve (stomach outlet) is kept intact
  • Intestines are not cut, bypassed, or rerouted
  • Short hospital stay
  • Quick recovery
  • Very low mortality rate (only 1 in 2000 vs. 1 in 200 for Roux-en-Y gastric bypass)
  • Lack of malabsorption (since part of the intestines are not bypassed)
  • Absence of dumping syndrome
  • Absence of anemia
  • Fewer complications than other weight loss surgery procedures

Possible Complications of Gastric Banding

Laparoscopic Adjustable Gastric Banding is a relatively safe type of weight loss surgery, but as with all surgery, it is necessary to consider the potential risks, complications, and side effects.

Some of the risks of lap band surgery are:

  • During surgery: hemorrhage; injury to spleen, stomach, or esophagus; conversion to open surgery
  • After Surgery: band slippage; balloon or tubing leakage; port or band infection; obstruction; nausea and vomiting
  • Long-Term: band erosion into stomach; esophageal dilatation; failure to lose weight

Adjusting Your Gastric Band

Gastric banding involves periodic band adjustments (fills) to promote ongoing satiety and weight loss.

  • Periodic adjustments are necessary because weight loss changes the fit of the band.
  • Adjustments are fast and easy, about 5 to 10 minutes in the doctor's office.
  • The first fill is made after the stomach has had time to heal; usually about 1 week after adding solid foods to the diet (4 to 6 weeks after surgery).

Further adjustments are made on a personalized time frame, based on satiety and weight loss progress.

Weight Loss Results with Gastric Banding

Compared to non-surgical treatment options for obesity, at least two-thirds of the adjustable gastric banding patients are able to lose at least 50% of their excess weight and keep it off for ten years or longer.

In addition to losing excess weight, the weight loss usually leads to an improvement or resolution of health conditions associated with obesity, such as type 2 diabetes, high blood pressure, and severe sleep apnea. In fact, gastric band surgery is so effective at treating obesity comorbidities that it is now being prescribed as a primary treatment for these health conditions.

Although the rate of weight loss in the first year is not as quick as with gastric bypass surgery, the weight loss at five years after surgery is approximately the same. The rate of weight loss with adjustable gastric banding is approximately 1-2 pounds per week, an amount considered healthy. A more gradual weight loss leads to less nutritional deficiencies and a lower incidence of side effects, such as gallbladder problems and hair loss. Overall, bariatric surgery patients can expect significant weight loss results at a healthy rate with laparoscopic adjustable gastric banding.

Gastric Band Video

The following video demonstrates the laparoscopic adjustable gastric banding procedure for obesity.

Play time: 3 min 18 sec

Development of Gastric Banding

When gastric banding was first introduced in 1978, the band was non-adjustable and implanted using open surgery. The original materials used for the gastric band did not perform well, progressing from Marlex mesh, Dacron graft, to PTFE (Gortex). It was not until 1983 that silicone was used to make the gastric bands, which is the material still used today. In 1986, the silicone band was modified to provide adjustability by adding inflatable balloons to the inner surface and connecting it with tubing to a small access port. Gastric banding placement was later modified to take advantage of newly emerging laparoscopic surgery techniques.

There are currently two brands of adjustable gastric bands available for use in the United States - the LAP-BAND System and the REALIZE Band (US marketing name for the Swedish Adjustable Band). The LAP-BAND System received US FDA approval in 2001, while the REALIZE Band received US FDA approval in 2007.

Both gastric bands were used worldwide prior to being available in the United States. The Swedish Adjustable Band was developed in 1985, but not used commercially until 1996. The LAP-BAND System, although developed by an American company, was first introduced to Europe in 1993. Although neither band was originally designed for laparoscopic placement, they have both been modified for this method of surgery. Another gastric band designed specifically for laparoscopic insertion, the MIDband, was introduced in 2000 in France. The MIDband (not available in the US) is a lower pressure, wider, and one-piece adjustable gastric band. There are now about six-eight band manufacturers worldwide. Besides the United States, the biggest users of the gastric band are Australia and France.