Laparoscopic adjustable gastric banding (LAGB) is a restrictive weight-loss surgery that places an inflatable silicone band around the upper part of the stomach. This band creates a small pouch, limiting the amount of food a person can eat and promoting an earlier feeling of fullness. The system’s adjustability is managed through a small device known as the access port. This port is the central point for managing the restriction level and is often the focus of patient curiosity regarding its physical presence under the skin.
Placement and Purpose of the Port
The port is a small, disc-like device connected to the band around the stomach by a thin tube. Its purpose is to allow a medical professional to add or remove sterile saline fluid from the band’s inflatable inner balloon. Adjusting the fluid volume changes the tightness of the band, thereby controlling the size of the stomach outlet, which is a process called a band fill or unfill.
Surgeons typically place the port just beneath the skin in the subcutaneous tissue of the upper abdomen. Common locations include the midline, often near the sternum, or the upper left abdominal wall. To prevent it from moving or flipping over, the port is secured with sutures to the abdominal wall fascia. Securing the port ensures it remains in a stable position for easy access during adjustment procedures.
Factors Influencing Visual Detection
The primary question for many patients is whether this port is visible through the skin, and the answer depends on several physical factors specific to the individual. The most significant variable is the depth of the subcutaneous fat layer covering the port. For patients with a higher body mass index (BMI) at the time of surgery, the thicker layer of fat often completely obscures the port from view.
As patients achieve significant weight loss, the fat layer thins out, which can increase the visibility of the port’s outline. This change can cause the port to become a slightly raised or noticeable bump under the skin, particularly when viewed from certain angles or in certain lighting. The surgeon’s specific placement technique also plays a role, as a port fixed more superficially beneath the skin will be more prone to visibility regardless of weight fluctuation.
Specific body movements, such as bending or twisting, or wearing very tight clothing can temporarily accentuate the port’s outline. Occasionally, the formation of scar tissue or a localized fluid collection (seroma) around the port site can also make the area appear slightly raised. If the port becomes highly visible after substantial weight loss, it can sometimes be replaced with a lower-profile device in a minor procedure to reduce its noticeability.
Sensation and Access During Adjustments
Even when the port is not visually apparent, it is designed to be palpable, meaning it can be felt by a doctor or the patient beneath the skin. The port typically feels like a firm, small, disc-like object anchored in place in the abdominal wall. In the initial post-operative period, the area may be sensitive, but long-term chronic pain at the port site is uncommon.
The port’s functional purpose is to allow for the band adjustment process, which is usually performed in an outpatient setting. During an adjustment, the patient lies down, and the medical professional locates the port through palpation. A special non-coring (Huber) needle is then inserted through the skin and directly into the port’s silicone septum. This needle is designed to minimize damage to the port material during repeated punctures.
The fluid is then injected or aspirated, which usually takes only a few minutes to complete. For challenging access, or if the port is tilted, the procedure may be guided by ultrasound or fluoroscopy to ensure accurate needle placement. Accessing the port through the skin allows for precise, non-surgical control over the band’s restriction level, making it a routine part of long-term band management.