A laparoscopic adjustable gastric band, commonly called a lap-band, a band, or LAGB, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to decrease food consumption.
Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35 and 40 in cases of patients with certain comorbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, hypertension (high blood pressure), or metabolic syndrome, among others.
However, an adjustable gastric band may be used only after other methods such as diet and exercise have been tried.
The inflatable band is placed around the upper part of the stomach to create a smaller stomach pouch. This slows and limits the amount of food that can be consumed at one time, thus giving the opportunity for the sense of satiety to be met with the release of peptide YY. It does not decrease gastric emptying time. The individual achieves sustained weight loss by choosing healthy food options, limiting food intake and volume, reducing appetite, and progress of food from the top portion of the stomach to the lower portion digestion.
However, gastric banding is the least invasive surgery of its kind and is completely reversible, with another “keyhole” operation. Gastric banding is performed using laparoscopic surgery and usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. Because no part of the stomach is stapled or removed, and the patient’s intestines are not re-routed, he or she can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they are able to stay in the patient’s body without causing harm.
However, not all patients are suitable for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery, or have complicating medical problems may require the open approach.
The surgical insertion of an adjustable gastric band is often referred to as a lap band procedure or band placement. First, a small incision (typically less than 1.25 cm or 0.5 in.) is made near the belly button. Carbon dioxide (a gas that occurs naturally in the body) is introduced into the abdomen to create a work space for the surgeon. Then a small laparoscopic camera is placed through the incision into the abdomen. The camera sends a picture of the stomach and abdominal cavity to a video monitor. It gives the surgeon a good view of the key structures in the abdominal cavity. A few additional small incisions are made in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel behind the stomach, inserts the gastric band through the tunnel, and locks the band around the stomach.
In general, gastric banding is indicated for people for whom all of the following apply:
Body Mass Index above 40, or those who are 100 pounds (7 stone/45 kilograms) or more over their estimated ideal weight, according to the National Institutes of Health, or those with a BMI between 30 and 40 with co-morbidities that may improve with weight loss (type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.)
- Age between 18 and 55 years (although there are doctors who will work outside these ages, some as young as 12).
- Failure of medically supervised dietary therapy (for about 6 months).
- History of obesity (up to 5 years).
- Comprehension of the risks and benefits of the procedure and willingness to comply with the substantial lifelong dietary restrictions required for long term success.
- Gastric banding is usually not recommended for people with any of the following:
- If the surgery or treatment represents an unreasonable risk to the patient
- Untreated endocrine diseases such as hypothyroidism
- Inflammatory diseases of the gastrointestinal tract such as ulcers, esophagitis or Crohn’s disease.
- Severe cardiopulmonary diseases or other conditions which may make them poor surgical candidates in general.
- An allergic reaction to materials contained in the band or who have exhibited a pain intolerance to implanted devices
- Dependency on alcohol or drugs
- People with severe learning or cognitive disabilities or emotionally unstable people
Clinical studies of laparoscopic bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.