Gastric Band Surgery (LAP-Band)
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.
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 control 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.
- Slippage of the band.
- Erosion of the band.
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. This is a common side effect in the early days after the surgery. It usually resolves over time, as you learn new ways of eating: smaller, more nutrient-dense meals, smaller bites and thorough chewing.
- Constipation. Some people develop constipation with the gastric band because they find it difficult to drink enough fluids. Your stomach won’t be able to hold much fluid at once, and your healthcare provider will direct you not to drink fluids while eating in order to leave room for your food. Hydration is very important after any type of bariatric surgery.
- Difficulty swallowing. Sometimes your body may react to the smaller stomach pouch and slower gastric motility by making it hard to swallow food. Loosening the band, or slowing down and eating smaller bites can help. If it doesn’t help, it could indicate an intolerance to the band.
- Gastroesophageal reflux. A tight band can trigger acid reflux (GERD), also called heartburn. Loosening it to relieve symptoms may interfere with weight loss. But, persistent GERD may damage the walls of your esophagus, causing acid erosion. GERD can often be treated with medication, but some severe cases may require removal of the gastric band.
- Port problems. The port that your healthcare provider uses to access and adjust your Lap-Band can malfunction in various ways. It can become dislodged from its original location or flip upside down, making it inaccessible from the outside. The port or tubing can leak, making it impossible to fill the gastric band. If you lose a lot of weight quickly, the port can stick out of your skin, causing tenderness or skin erosion at the site. These malfunctions may require minor operations to fix or replace the port. Infections at the port site can also happen, which may require antibiotics or an additional procedure to correct.
- Outlet obstruction. Food can get stuck in the outlet between your stomach pouch (stomach above the band) and lower stomach, causing a blockage. You’ll notice when you can’t eat anymore. Your healthcare provider can try to clear the blockage by deflating the band, but it might need surgery to fix.
- Band slippage. The band is secured in its position during the surgery. However, the band could slip from this position. When this happens, the stomach pouch (stomach above the band) becomes bigger. If this happens slowly, this may affect your weight loss benefits, or cause symptoms such as reflux. Sometimes it can happen very quickly, which can cause stomach necrosis (dying of stomach tissue). This would require emergency surgery and removal of the band.
- Esophageal dilation and/or pouch dilation. Pressure from food building up above the gastric band can cause your stomach pouch — and sometimes your esophagus — to dilate or widen. This allows more food to back up above the band, causing nausea, reflux and vomiting. It may take surgery to correct, and/or removal of the band.
- Band erosion. Friction from the band rubbing against your stomach or your esophagus over time may cause the band to erode through your stomach. This makes the band ineffective and can also cause infection. The solution is usually removal.
- Band intolerance. Some people have adverse reactions to a foreign implant in their bodies. They may develop excessive scar tissue around the band, or feel persistent nausea and discomfort. In these cases, the band may have to be removed.
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.
A note from Cleveland Clinic
Any bariatric surgery is a major commitment with important pros and cons to consider. Gastric band surgery is no exception. As a reversible and removable option that doesn’t require cutting your organs, the Lap-Band may be an easier commitment up front. It also means more follow-up care, however, including frequent adjustments in the first year or two and possible revision surgeries later on. And it will require lifelong changes to your eating habits.
For some people, this is the option they need to take the next big step toward significant weight loss and lifelong change. Depending on how it works for you, it might be the end of your weight loss journey, or a step along the way. Some people use the Lap-Band to effectively retrain themselves to change the ways that they eat and live. Others may fail to lose enough weight or maintain their weight loss over time. If this happens, you’ll have other treatment options.
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