ARH Bariatrics

Laparoscopic Adjustable Gastric Band

The Laparoscopic Adjustable Gastric Banding System is an adjustable silicone banding device that is fastened around the upper end of the stomach to create a smaller stomach reservoir (pouch). We use the only United States Food & Drug Administration (FDA) approved band on the market today.

There are two types of LAGB available today. The LAP-BAND® Adjustable Gastric Band made by the Inamed Corporation. The other LAGB is the Realize™ Band by Johnson & Johnson.

In this procedure, the surgeon makes several small incisions through which the laparoscopic instruments are inserted to place and fasten the LAGB around the upper portion of the stomach. There is a small port attached to the band that is secured to the underlying abdominal muscle that is easily accessible for adjustments. Adjustments take only a few minutes and are performed in the office without sedation.

Most people need only one or two adjustments after surgery, but depending upon their eating habits and the amount of weight lost they may require more. This procedure functionally restricts the size of the stomach to about 2-oz and is considered a strictly gastric restrictive procedure, although some suggest when it’s appropriately adjusted, it does decrease one’s appetite, as well. The difference between this and other restrictive bariatric procedures is that the restrictive effect can be adjusted. This is currently the only bariatric procedure that can be adjusted without surgery in the post-operative period. Weight loss occurs by restricted intake – the smaller stomach pouch creates the sensation of fullness earlier (satiety), thereby decreasing the desire for food and limiting the volume of food one is capable of consuming at one time.

There is no division or bypass of the stomach in this procedure. Of note, with this limit intake, if you eat too much at one meal, you may feel discomfort and may even vomit until you learn the capacity of your “new” stomach. It generally carries the least complications of the current bariatric procedures. Weight loss is more gradual than other bariatric procedures and eating high calorie liquid or soft foods can circumvent the procedure. There is no malabsorption of nutrients, no “leaks”, and no “dumping” (see below).

The usual hospital stay is less than 23 hours (outpatient or same day surgery). Weight loss with the Laparoscopic Adjustable Gastric Banding System is reported at 35-68% of excess body weight. Health problems associated with excess weight are also usually benefited or resolved. Lastly, the Laparoscopic Adjustable Gastric Band is easily reversible/removed and can be laparoscopically converted to a Roux-en-Y gastric bypass if needed or desired.

Advantages of LAGB:

• No cutting of the stomach
• Quick operative time
• Outpatient surgery
• The only adjustable bariatric procedure available today
• Proven to be the safest bariatric procedure available today
• Reversible
• Weight loss equivalent to gastric bypass after 2 – 3 years in compliant patients
• Less chance of protein or vitamin deficiency, and hair loss
• Can be converted laparoscopically to a gastric bypass
• Weight loss of 35 - 65% excess body weight at 2 – 3 years
Disadvantages/Risks of LAGB:

• Slower, more gradual weight loss than the gastric bypass
• 1- 2% risk of slip requiring laparoscopic revision
• Less than 1% risk of infection which would require removal of the port and/or band