Laparoscopic Adjustable Gastric Band

Like the gastric bypass and sleeve gastrectomy, the laparoscopic adjustable gastric band (LAGB) procedure reduces the effective size of the stomach. Instead of stapling and dividing the stomach, with the adjustable gastric band this restrictive effect is accomplished using a plastic band that fits around the top part of the stomach like a belt. The band is hollow and is filled with fluid. By adding or removing fluid from the band, the band can be tightened or loosened.

Once the band is properly adjusted, the small stomach pouch fills with food rapidly and empties slowly. When the pouch gets full, the brain responds with a feeling of fullness even though the person has only consumed a very small amount of food. 

The result is that fewer calories are consumed over the course of the day, which in the long run leads to weight loss that can be maintained for life.

History

The concept of an adjustable gastric band originated in Europe in the mid-1980s. In the United States, there are currently two brands of adjustable gastric band that have been approved by the FDA. The Lap-Band system (from InaMed, now Allergan) was initially introduced in Europe in 1993. It was approved by the FDA for use in the US in 2001. The Realize Band (Ethicon) obtained FDA approval in 2007, but was actually developed in Europe first (1992, known at that time as the Swedish Adjustable Gastric Band or SAGB).

Conceptually, these two types of bands work in the same way to restrict the stomach. The surgeons at the Hickory Surgical Clinic have extensive experience implanting both types of band.

Minimally Invasive Approach

In our program, LAGB procedures are nearly always performed with a minimally invasive laparoscopic technique. This means that instead of a large incision, the operation can usually be completed through several small incisions in the abdomen. We use a video camera (called a "laparoscope") to view the inside of the abdominal cavity, and surgical staplers to divide the tissues and make the new connections.

The advantages of laparoscopic surgery include better cosmetic results, fewer wound-related complications, and a faster recovery with quicker return to work and other activities.

In appropriate case, we often find that we can insert all the instruments we need through a single incision (where the port is implanted). Often this incision can be partially concealed in the umbilicus (bellybutton). This technique, called "single-incision laparoscopic surgery" or SILS, may offer some cosmetic benefits; on the inside, the procedure is exactly the same.

Surgical Technique

The laparoscopic adjustable gastric band (LAGB) procedure involves two basic steps:

1. Secure the band around the upper part of the stomach. This creates a small stomach pouch, restricting the amount of food that can be eaten before feeling full.
2. Attach the injection port. The port is attached to the tubing and secured to the abdominal muscle; the port is used to adjust the band tightness after surgery.

Watch for these two major steps in the following video:

How Does the Band Work?

The band works entirely by restricting the stomach pouch. With proper food choices, patients should expect a sense of satiety with smaller meals. Patients who have an adjustable gastric band do not experience the "dumping syndrome" that gastric bypass patients can get when they eat sweet or fatty foods. 
 
One of the advantages of the adjustable gastric band procedure is that it is a less complex operation than most other weight loss operations. There is no stapling, cutting, or rerouting of the stomach or intestines. This generally leads to a shorter length of time in the operating room under anesthesia, and a shorter length of stay in the hospital. Since there are no staple lines, there is a lower risk of leaking. The band is also adjustable – it can be tightened or loosened depending on the needs of the patient. This procedure is also more easily reversible than other weight loss operations.

The disadvantages of the adjustable gastric band procedure includes a generally slower initial weight loss than with gastric bypass surgery. Some patients may take up to three years to achieve their final weight loss results. Also, overall long-term weight loss results may not be as good with the adjustable gastric band as with gastric bypass. 

What are the Risks of LAGB?

There are risks associated with any major surgical procedure, including pain, bleeding, infection, heart or lung complications, blood clots (deep vein thrombosis or pulmonary embolism), injury to adjacent organs, drug reactions, anesthesia complications, and death. Some laparoscopic procedures require conversion to a traditional "open" approach with a larger incision.

Some risks that are specific to the laparoscopic adjustable gastric band procedure include:

Band slippage Band erosion Port displacement Port site infection Mechanical failure (leak, etc)

Esophageal spasm Esophageal reflux (GERD, heartburn) Inadequate weight loss Weight regain Possible need for additional surgery

What are the Results of LAGB?

After the laparoscopic gastric banding procedure, patients typically experience progressive weight loss for the first 2-3 years after surgery. Patients can lose 50% of their excess body weight, and maintain their weight loss long-term. To achieve the best weight loss results, patients must be prepared to maintain consistent food choices, and undergo adjustments of the band at regular follow-up intervals after surgery.

 

Making a Choice

Is surgery the right choice? If so, which procedure? How does the laparoscopic adjustable gastric band procedure compare to other choices like the laparoscopic gastric bypass or the laparoscopic sleeve gastrectomy? Browse our site for more information, or call us with any questions.

If you feel that you or someone you love might benefit from weight loss surgery, or if you would like any additional information, please contact us at 828-327-9178. Or click here to see how to get started in our program.