One of the surgical treatments for obesity is called laparoscopic adjustable gastric banding (LAGB), commonly known as lap-band surgery.
It is a surgical procedure during which an adjustable band is placed around the upper portion of the stomach and restricts the size of the stomach and the amount of food it can hold.
The band is silicone-made and connected to a port that is placed under the skin in the abdomen which is used to fill or remove saline from the band so it can be tightened.
Candidate for the lap band system has a body mass index over 40 kg/m2, or more than 45 kilograms over their ideal body weight. Also, the procedure can be performed on a person with a BMI of 35-40 kg/m2 if there are medical problems that are weight-related, such as high blood pressure (hypertension) or diabetes.
The procedure is indicated for adults only. It is contraindicated if the potential patient has difficulty understanding the procedure, is emotionally unstable, or is dependent on drugs or alcohol.
Lap band surgery can be performed by qualified bariatric surgeons. It is done under full general anesthesia and takes about 1 to 2 hours to perform. First, the surgeon will make 3 to 5 small incisions, each about 1 inch in length.
Through one of the incisions, the surgeon inserts a small camera attached to a tube so he/she can view the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.
The patient will stay in the hospital for a short period of time and generally, most people can return to work 1 week after surgery (if their job is not too physically demanding) and normal activity can usually resume after 6 weeks.
After 6 to 8 weeks, the band will be adjusted with the first fill of saline injected into the port just under the skin which is connected to the band. The fill is painless and it is usually performed by the surgeon 2who performed the procedure.
Band adjustments will be made temporarily to enhance weight loss, especially if there is a plateau phase in weight loss, and sometimes to overcome side effects such as nausea and vomiting (in this latter case, the band is loosened).
Weight loss with LAGB is a gradual process and sometimes the patient can lose 2 to 3 pounds per week, but after about 18 months the weight loss tends to slow significantly. The average weight loss for this procedure is 40% of excess body weight in the first year, with an additional 10% to 20% in the second year.
Side effects of lap band surgery include:
- Nausea and vomiting
- Ulceration at the band site
- Esophageal reflux (indigestion)
- Weight regain
- Dehydration and constipation
The risk of lap band surgery is low. Complications can include the possibility of the band slipping or eroding into the stomach and of mechanical malfunction, infection, bleeding, and/or abdominal pain.
