Gastric Band Surgery (Lap-Band)

Gastric band surgery is one type of bariatric surgery procedure that’s adjustable and reversible. It involves placing a silicone band called the Lap-Band around your stomach. The gastric band reduces your stomach capacity and slows the passage of food through your stomach. This can retrain you to eat less.

Overview

The gastric band is connected to an external port that your healthcare provider can use to adjust the tightness.

What is gastric band surgery (Lap-Band)?

The adjustable gastric band is a surgically implanted device to help people with obesity lose weight. It’s one of several types of bariatric surgery that restrict how much you can eat at one time (restrictive weight loss surgery). The adjustable gastric band reduces the size of your stomach without permanently dividing it as other surgeries do. The “Lap-Band” is the only brand of gastric band that is currently available in the U.S. It was approved by the FDA in 2001.

How does the gastric band (Lap-Band) work?

The gastric band is an adjustable, inflatable tube made of soft silicone. It’s placed around the upper portion of your stomach to form a ring. This inflatable ring is connected to a port that is placed underneath your skin. Your surgeon can tighten the fit of the band by accessing the skin port and injecting with saline fluid, enough to allow a small outlet between the upper portion of your stomach and the lower part. When you eat, this upper stomach pouch will fill up quickly, making you feel fuller faster.

Who is gastric band surgery for?

In general, you may be a candidate for bariatric surgery if you’re suffering from health conditions related to obesity and if other methods of weight loss haven’t worked for you. Your healthcare provider may suggest the Lap-Band if you’re looking for an intervention that’s less invasive and less permanent than other weight-loss surgeries.

Compared to other bariatric procedures, the gastric band has the lowest complication rate after surgery, and there is no division of stomach or intestines. It can also be removed if needed. However, the Lap-Band leads to less weight loss than other bariatric procedures. It also requires several frequent follow-up office visits and adjustments, especially over the first year.

Currently, other bariatric surgery procedures, like the sleeve gastrectomy and the roux-en-Y gastric bypass, are more widely used. As of 2019, the rate of gastric band surgery was estimated to be 0.9% of all bariatric procedures performed in the United States.

How much weight can you lose with Lap-Band?

The average weight loss with Lap-Band is about 40% of excess weight over two years. That means if you were 100 lbs. overweight, you’d lose 40 lbs. Results can vary, depending on how much you change your habits after surgery. Weight loss with the gastric band is typically less than with other bariatric surgeries.

Can gastric banding help treat obesity-related health conditions?

Just losing weight can do a lot to improve obesity-related health conditions, including:

• High cholesterol.
• High blood pressure.
• Heart disease.
• Type 2 diabetes.
• Obstructive sleep apnea.
• Non-alcohol related fatty liver disease.

The gastric band doesn’t have the same effects on metabolism and hormones as other weight-loss surgeries. It’s considered a purely “restrictive” procedure, meaning that it works primarily by limiting the amount of food you can eat at one time.

Procedure Details

What are the requirements to qualify for Lap-Band surgery?

Your healthcare provider may recommend bariatric surgery if you have:

• A BMI of 40 or higher. The Body Mass Index (BMI) is a way of estimating how much body fat you have based on your height-to-weight ratio. A score of 40 or higher is associated with a higher risk of obesity-related diseases.
• A BMI of at least 35 and at least one obesity-related disease. A BMI of 35 without a related disease is considered class II obesity. With a related medical problem, it qualifies as clinically severe, or class III obesity.

You’ll also have to undergo medical screening to make sure you’re healthy enough for surgery. You may have physical exams, blood tests, or imaging tests of your abdomen. If you smoke or overuse alcohol or opioids, you’ll have to quit before qualifying for surgery.

Is Lap-Band a major surgery?

This is a subjective question. However, the procedure and recovery time are relatively short, and like most bariatric surgeries, you can have the adjustable gastric band installed by minimally-invasive surgery methods (laparoscopic surgery). This means that instead of one large incision across your abdomen, your surgeon can perform the entire operation through a few small “keyhole” incisions.

What happens during the Lap-Band procedure?

• You’ll be put under general anesthesia, so you’ll be asleep and unaware during the operation.
• Laparoscopic surgery begins with a single keyhole incision in your abdomen. Your surgeon will use this first keyhole to install a tiny pump and inflate your abdomen with carbon dioxide gas. This allows for your surgeon to see, and for there to be room to perform the surgery.
• Your surgeon will install the laparoscope — a tiny lighted video camera. The laparoscope will project your organs onto a screen. Your surgeon will use long, narrow tools to access your stomach through additional keyholes.
• Your surgeon will secure the gastric band around the top portion of your stomach and tighten it to form a pouch. Your stomach will look a bit like an hourglass, with a narrow channel between the top and bottom portions.
• The gastric band has a hollow channel that can be filled with fluid. This is what makes it adjustable. Your healthcare provider will be able to adjust the pressure of the gastric band by adding or extracting fluid through this port.
• The gastric band is attached to a small plastic tube that will run just under your skin and into a port. After surgery, your healthcare provider will be able to access the port with a special fine needle to inject or extract fluid as needed.
• When everything is in place, your surgeon will release the gas from your abdomen and close your keyhole incisions. The procedure takes about 30 to 60 minutes.

What will my diet be like after gastric band surgery?

Your healthcare provider will give you specific dietary instructions. You’ll be on a liquid diet for the first several weeks, gradually progressing from pureed foods to soft foods and finally, solid foods. This is to give your stomach time to heal. When you do return to solid foods, you’ll have to limit your portions to fit your new stomach pouch. Overeating will likely cause nausea and vomiting. You’ll have to choose high-quality foods to make sure you get enough nutrients and chew your food well.

What kind of follow-up care will I have?

You'll visit your healthcare provider often in the first year after surgery to make adjustments to your gastric band. As you lose weight, your Lap-Band may need to be tightened in order for you to sustain your weight loss. You’ll also have regular blood tests to make sure you’re getting enough nutrients on your new diet. You may have nutritional counseling to help you learn new ways of eating. If necessary, your healthcare provider may prescribe supplements.

How many years does a LAP-Band last?

The Lap-Band is designed to last a lifetime, but whether it does isn’t yet proven. Studies show that 35% to 40% of people may have their gastric bands removed after 10 years.

There are many reasons why the gastric band may be removed, including:

• Inadequate weight loss.
• Complications such as esophageal dilation.
• Severe heartburn/reflux.
• Inflection.
• Slippage of the band.
• Erosion of the band.
• Obstruction.

Some people eventually move on to a more permanent bariatric surgery with a higher success rate.

Risks / Benefits

What are the advantages of gastric band surgery over other types of bariatric surgeries?

The main advantage of the adjustable gastric band is that it has a lower risk of complications immediately after surgery. While sleeve gastrectomy and gastric bypass are both considered very safe, the gastric band is estimated to have an even lower risk of complications. There’s no division of your stomach or intestines involved. Additionally, it can be removed if necessary.

What are the disadvantages of gastric band surgery?

There are several disadvantages to gastric band surgery. First, it leads to less weight loss than the other bariatric surgeries. It also may require frequent adjustments, especially during the first year after placement.

Over time, there may be additional issues that arise. For example:

• Studies suggest the risk of complications after a gastric band to be as high as 50%.
• The rate of repeat procedures to fix or remove the gastric band may be as high as 35%.
• The rate of failure due to inadequate weight loss or regaining weight is higher with gastric band than with other bariatric procedures.
• Additional surgery means additional expense and risk.

What are the possible complications or side effects of the Lap-Band?

• Nausea and vomiting.
• Constipation.
• Difficulty swallowing.
• Gastroesophageal reflux (GERD).
• Port problems.
• Outlet obstruction.
• Band slippage.
• Esophageal dilation and/or pouch dilation.
• Band erosion.
• Band intolerance.

Recovery and Outlook

What is the long-term outlook after gastric band surgery?

Many people lose weight with the gastric band in the first year or two after surgery. The gastric band placement itself rarely causes complications immediately after surgery, but some complications may develop down the road. Complications may require reoperation or removal of the Lap-Band. Some people decide after removal that they desire another bariatric procedure.