Laparoscopic Adjustable Gastric Banding (LAGB), often known by the brand name Lap-Band, is a weight-loss procedure involving the placement of a silicone ring around the upper part of the stomach. This device is designed to restrict the amount of food a person can consume at one time, promoting a feeling of fullness after smaller meals. While the procedure is still available and FDA-approved, its use in bariatric surgery has significantly declined in recent years, largely supplanted by other surgical methods that have demonstrated better long-term outcomes for most patients.
The Mechanism of Laparoscopic Adjustable Gastric Banding
The procedure is performed laparoscopically, involving small incisions in the abdomen. During the surgery, a hollow, adjustable silicone band is placed around the uppermost section of the stomach, creating a small pouch above the band. This small pouch physically limits the quantity of food that can be held, which is the primary restrictive mechanism of the surgery.
The band is connected by tubing to an injection port that is secured just beneath the skin of the abdomen. Surgeons can adjust the band’s tightness by injecting or removing sterile saline solution through this port. Adding saline inflates a balloon on the inner surface of the band, constricting the opening between the small upper pouch and the rest of the stomach. This adjustability allows the restriction level to be tailored to the patient’s weight loss progress and tolerance.
Current Status and Availability of the Procedure
Laparoscopic Adjustable Gastric Banding remains an available option, and the “Lap-Band” device is the only gastric band currently approved by the FDA for use in the U.S. Despite its continued approval, the number of procedures performed has decreased dramatically. In the early 2010s, LAGB accounted for a significant portion of bariatric surgeries, but its prevalence has since fallen to less than 5% of all bariatric procedures in the U.S.
Many major bariatric surgery centers have either significantly reduced or stopped offering the procedure entirely. The band is now often reserved for highly specific patient cases, such as those who may not tolerate the more involved risks of other surgeries or those who strongly prefer a reversible option. For most patients seeking weight loss surgery today, the gastric band is no longer considered a first-line treatment.
Why Clinical Use Has Declined
The primary reason for the clinical decline of the gastric band is the generally inferior long-term results compared to modern alternatives. Studies consistently show that the weight loss achieved is less substantial than with other bariatric surgeries, with patients typically losing around 15% of their total body weight.
A significant concern is the high rate of long-term complications and the need for subsequent operations. More than half of all gastric bands require removal or revision surgery within 7 to 10 years due to issues like inadequate weight loss or complications. Common complications include band slippage (where the device moves out of position) and band erosion (where the band wears into the stomach wall). Other frequent problems are port infection, pouch dilation, and food intolerance, which can cause severe nausea and vomiting. These issues often necessitate the band’s removal, with some studies reporting removal rates as high as 60%. The high likelihood of a second surgery has made the procedure less attractive to both surgeons and patients.
Primary Modern Bariatric Surgery Alternatives
The procedures that have replaced the gastric band as the standard of care are the Sleeve Gastrectomy and the Roux-en-Y Gastric Bypass. The Sleeve Gastrectomy (VSG) is a purely restrictive procedure where approximately 80% of the stomach is permanently removed. The remaining stomach is a narrow tube that limits food intake and reduces the production of the hunger hormone ghrelin, leading to greater weight loss than the band.
The Roux-en-Y Gastric Bypass is both a restrictive and malabsorptive procedure. It involves creating a small stomach pouch and then rerouting the small intestine to connect to this pouch. This bypasses a large section of the digestive tract, reducing the amount of calories and nutrients absorbed. Gastric bypass often results in the most significant long-term weight loss and the greatest improvement in conditions like type 2 diabetes.
Both the sleeve and the bypass offer higher average weight loss and lower long-term revision rates compared to the gastric band. The shift toward these alternatives reflects a consensus that they provide better, more durable outcomes for the majority of patients seeking surgical treatment for obesity.