How Does Laparoscopic Adjustable Gastric Band Work?

Also known as the lap band, adjustable gastric band is a restrictive weight loss surgery procedure. The size of the stomach is reduced using a band—an inflatable, silicone, ring-shaped tube. The band wraps around the upper portion of the stomach creating a small pouch the size of half a cup. The pouch connects to the lower part of the stomach through a small opening. The diameter of this opening is determined by the amount of saline solution contained in the tube.

Saline solution can be injected to or removed from the tube using a needle that enters through a small access port placed under the skin of the patient’s abdomen. This way the degree of restriction can be adjusted. As food slowly moves from the top of the stomach (pouch) to the lower part of the stomach, digestion takes place normally. However, since the pouch is very small comparing to the whole stomach, it fills up very fast. Once a small amount of food is consumed, the patient feels full and stops eating, which results in weight loss.

FDA in the US has approved two types of Lap Band systems to date: the Lap Band by Allergan) and the Realize Band (by Ethicon Endo-Surgery). The structure of the band device is similar in both systems and so is the weight loss outcome.

Expected Weight Loss After Gastric Band Surgery

Gastric band patients lose on average 38% of their excess weight within 21 months, according to the 2009 clinical study by Strain and colleagues.

Pros

• The gastric band is less invasive than any other type of weight loss surgery. Gastric band is performed laparoscopically through 5 small incisions near the belly button, which results in smaller scars and less pain than open surgery.

• It does not change the anatomy of the intestines nor does it remove any part of the digestive system

• Requires shorter hospital stay. Patients can leave the hospital as soon as 6 hours post-operatively. No need to stay overnight in the clinic.

• Faster recovery. Patients can resume office work within a week.

• Has no risk for nutrient deficiency. Since the digestive tract stays intact, digestion and absorption of nutrients proceeds normally.

• It is reversible. The band can be removed leaving the digestive system as it was in the beginning.

• It is adjustable. Gastric band is the only weight loss surgery where the rate and amount of weight loss can be customized and controlled.

Cons

• Being a purely restrictive and minimally invasive procedure, gastric band surgery causes less weight loss than other more invasive surgeries that are both restrictive and malabsorptive.

• Since gastric band does not involve any intestinal bypass (malabsorption), the potential for inadequate weight loss and even weight regain exists and it is higher than that with other more invasive procedures.

• Requires the most dietary effort of all procedures to be successful. Patients have to follow a certain diet otherwise the weight will creep back.

Risks and Complications of Gastric Band Surgery

• Low death risk. The death risk from Laparoscopic Adjustable Gastric Band is 0.5%, the lowest of all bariatric surgeries.

• Band slippage. The band may move from its original position making the pouch bigger. In case of a slippage, the band will have to be repositioned or removed temporarily.

• Band erosion. This is the case when the band causes erosion of the stomach wall. The band will have to be removed causing weight regain.

• Abdominal pain, difficulty swallowing and vomiting are common side effects of laparoscopic adjustable gastric band.

About the author
Matthew Denos, PhD, writes on a wide range of weight loss surgery topics, including lap band surgery in South Florida and post-operative support for gastric bypass and sleeve gastrectomy patients.

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