Lap-Band Surgery: Overview

Lap-band surgery, or gastric banding, is a type of bariatric (weight loss) procedure. The surgery works by placing a tight, adjustable band around the top part of the stomach to compartmentalize the organ. The upper pouch is intentionally made smaller to restrict the amount of food it can hold and, therefore, that a person can consume comfortably.

What Is Lap-Band Surgery?

Gastric banding surgery is performed by a bariatric surgeon in a hospital or surgical center under general anesthesia. This scheduled, inpatient surgery reduces the effective capacity of the stomach to receive food and is, therefore, considered a solely restrictive procedure.

During the surgery, the surgeon places an adjustable, inflatable silicone band around the stomach, dividing it into two pouches—a small one located above the band and a larger one below it—with a passage called a stoma connecting the two.

When food reaches the stomach, it enters the smaller pouch first. Given its size, the amount a person can eat at any single sitting without experiencing pain or vomiting is limited. This leads to less consumption.

In addition to being a reversible surgery (the band is removable, so it does not permanently alter the anatomy of the stomach), the band can be adjusted by injecting or removing saline from it via a port located underneath the skin of the abdomen. Adding saline slows the movement of food from the top to the bottom parts of the stomach, while removing saline speeds it up.

These adjustments can be easily performed in the surgeon's office.

"Lap-Band surgery" is a term that originated from the brand name of a commonly used implant, the Lap-Band, made by Allergan. However, many have come to use "lap-band surgery" to describe all gastric banding procedures no matter what brand of implant is used.

Surgical Techniques

Gastric banding surgery is almost always performed laparoscopically, meaning that the surgeon uses long, thin instruments to operate through tiny incisions made in the abdomen. As such, the procedure is often called laparoscopic adjustable gastric banding (LAGB).

Less commonly, the procedure is performed as an open surgery. This means that the surgeon accesses the stomach through a large incision in the abdomen.

Compared to open surgery, laparoscopic gastric banding surgery typically allows for a shorter operation time and a faster recovery.

Criteria and Contraindications

For lap-band surgery, body mass index (BMI) is the most commonly used measure to correlate weight and height. It uses weight and height to try and estimate body fat. The resulting number is then used to categorize people as underweight, normal weight, overweight, obese, or morbidly obese.

The indications for undergoing lap-band surgery are:

• BMI over 40
• BMI of 35–39.9, with at least one serious health condition, such as type 2 diabetes, high blood pressure, or obstructive sleep apnea
• BMI of 30–34.9, with type 2 diabetes or metabolic syndrome that is uncontrolled with medical therapy

An exception to the above criteria is that Asian patients who have poorly controlled type 2 diabetes and a BMI as low as 27.5 may be considered for surgery.

This exception exists because, when compared to whites, Asians are more likely to accumulate fat in their abdomen (called central obesity). This increases their risk of insulin resistance and heart disease, even at relatively low BMIs.

Contraindications to undergoing gastric band surgery include:

• Severe heart failure
• Unstable coronary artery disease (symptoms like shortness of breath and chest discomfort)
• End-stage lung disease (the most severe form of lung disease)
• Portal hypertension (elevated pressure in the portal vein leading to the liver)
• Active cancer treatment
• Drug and/or alcohol dependency
• Impaired intellectual capacity
• Intolerance to general anesthesia
• Inability to follow up frequently after the surgery
• Unwillingness or inability to adhere to post-surgical dietary recommendations

Potential Risks

Specific risks associated with lap-band surgery include:

• Failed weight loss: Typically defined as a loss of less than 20% of excess weight
• New or worsening gastroesophageal reflux disease (GERD), stomach acid that backs up into the esophagus
• Band slippage: When the band migrates from its position around the stomach, leading to the collapse of the stomach above or below the band
• Pouch dilation: When the pouch enlarges due to high pouch pressures
• Port prominence: With massive weight loss, the port may become visible underneath the skin.
• Stomal obstruction: When the flow of food from the gastric pouch to the rest of the stomach is blocked
• Band erosion

Purpose of Lap-Band Surgery

The purpose of gastric banding surgery is twofold—weight loss and reversing or improving obesity-related conditions, such as hypertension (high blood pressure), type 2 diabetes mellitus (high levels of sugar in the blood), and sleep apnea (breathing stops and starts several times while asleep).

It's important to understand that meeting the above-mentioned criteria for gastric banding surgery (or another bariatric surgery) is only the first step. You must also be cleared medically and psychologically for surgery.

To be cleared for surgery, several preoperative tests and assessments need to be performed, such as:

• Blood tests, such as a fasting lipid panel, thyroid-stimulating hormone, and hemoglobin A1C
• Nutrient screening, such as for iron, vitamin B12, folic acid, and vitamin D
• An electrocardiogram (ECG), chest X-ray, and an overnight sleep study 
• A psychosocial-behavioral evaluation to assess your motivation and executive functioning skills for adhering to postsurgical dietary and exercise recommendations
• A consultation with your primary care physician to ensure cancer screening tests are current
• Pregnancy counseling for women who become pregnant after gastric banding and will require band adjustments to allow for appropriate weight gain for the baby's health
• Smoking cessation counseling (if applicable)

Weight Loss Expectations

According to the Cleveland Clinic, lap-band surgery can help you lose about 40%–50% of excess weight in two years.

The research on long-term weight loss outcomes after undergoing gastric banding is mixed. For instance, one review study found that after 15 years, patients were still able to keep off nearly half (47%) of the excess weight they carried prior to the procedure.

On the other hand, another study (albeit a smaller one) found that only 11% of people who had their surgery for an average of 11 years achieved a satisfactory excess body weight loss percentage (defined as over 50%).

How to Prepare

Once you are cleared for surgery, your doctor will provide instructions on how to prepare.

These instructions may include:

• Enrolling in a bariatric surgery education program
• Stopping smoking at least six weeks prior to surgery
• Renting or buying equipment for the home recovery period, such as a shower head with a detachable hose, and a toilet lift
• Stopping certain medications, including weight-loss drugs and nonsteroidal anti-inflammatory medications (NSAIDs) for a period of time before surgery
• Starting a clear liquid diet two days prior to surgery and then refraining from drinking anything after midnight on the eve of your surgery
• Packing items needed for a hospital stay, including comfortable clothes to go home in

What to Expect on the Day of Surgery

Upon arriving at the hospital, you will go to a preoperative room where you will change into a hospital gown. A nurse will then check your vital signs and place an intravenous (IV) catheter in a vein in your arm.

Once in the operating room, you will be given general anesthesia. You will not feel any pain during the surgery or remember the procedure afterward. After the anesthesia is given, a surgical scrub technician will clean your abdomen with an antiseptic solution.

You can then expect the following steps:

• Incision(s) made: If the surgery is laparoscopic, the surgeon will make several tiny incisions (one-quarter to one-half inch) in the abdomen through which a camera and long, thin surgical instruments will be inserted. If the surgery is open, a single large, 10- to 12-inch incision will be made in the abdomen.
• Band placement: Through the incision(s), the surgeon will place an adjustable gastric band (a soft silicone ring) around the upper stomach. The band will be tightened to create a small stomach pouch.
• Port placement: The surgeon will position a small port under the skin of the abdomen and attach the band to the port via thin tubing.
• Closing: The surgeon will then remove the instruments and close the incision site(s) with absorbable sutures and sterile tape. 

Anesthesia will then be stopped, and you will be taken to a recovery room to wake up.

Recovery

While awakening in the recovery room, it's normal to experience nausea and pain. Medications may be given to help ease these symptoms. After a couple of hours, you will be transferred to a hospital room, where you can expect to stay for around one night.

During your hospital stay, your vital signs will be closely monitored, and you will be visited by members of your bariatric surgical team.

Patients are encouraged to start getting up and walking around as soon as possible after surgery. Walking can enhance healing and help prevent blood clots from developing, so it is worth the effort it will undoubtedly take you.

To prevent pneumonia, you will also be encouraged to perform deep breathing exercises with a plastic device called an incentive spirometer.

Soon after surgery, you will begin drinking clear liquids. A clear liquid diet will continue for the first week or two, and then you will slowly progress to puréed foods, then soft foods, and then solid foods.

Your surgeon will discharge you when your vitals are stable, your pain is under control with oral medication, and you are able to drink adequate amounts of fluids.

Upon discharge, you can expect some of the following instructions:

• Take frequent walks daily with a goal of walking 2 miles daily by six weeks.
• Avoid strenuous activities for three to six weeks after surgery.
• Avoid heavy lifting (more than 20 to 30 pounds) for six weeks after surgery.
• When showering, wash your wound site(s) with mild soap and gently pat skin dry afterward with a clean towel.
• Avoid taking a bath or swimming until your surgeon gives you the OK (usually around three weeks after surgery).
• Drink frequent, small glasses of water with a goal of 1.5–2 liters per day.
• Avoid driving for one week or until you are off all pain medications.
• Take daily nutritional supplements as directed.

Long-Term Care

After gastric banding surgery, you will need to follow-up with your surgeon frequently for band adjustments. These band adjustments are important for maximal and sustainable weight loss.

You will also need to be monitored closely by your surgeon for long-term complications that may warrant band removal and revision surgery, or conversion to another weight-loss surgery (like a Roux-en-Y gastric bypass). Such complications include weight regain, band slippage, and pouch dilation.

Regular—ideally lifelong—visits with a bariatric dietitian are also warranted in order to ensure healthy eating habits and to monitor for nutritional deficiencies, which may occur from reduced food intake.

Lastly, besides the close follow-up and monitoring that's required, it is important to consider the emotional and psychological consequences of weight-loss surgery and obesity. Some patients struggle to cope with stress or experience body image issues or depression after surgery, perhaps due to their inability to overeat and their drastic weight loss.

Joining a bariatric support group or seeking out help from an experienced therapist or psychologist may help you better understand psychological difficulties you may be having and develop healthy coping strategies.

A Word From Verywell

If you or a loved one are considering this surgery, it's important to talk with your surgeon about realistic expectations. Be sure to also inquire about how gastric banding compares with other weight-loss surgery options. You will want to be as informed and as comfortable as possible with your decision.