Laparoscopic adjustable gastric banding, often known as Lap-Band, gained significant attention in the early 2000s as a less invasive option for treating severe obesity. This surgical technique restricts the stomach’s capacity to intake food without permanently altering the digestive tract’s anatomy. Its initial popularity was driven by perceived safety, reversibility, and the lack of intestinal rerouting. However, as long-term data emerged, the frequency of this operation changed considerably, leading many to question its current standing within modern weight loss surgery options.
Current Role of Adjustable Gastric Banding
Adjustable gastric banding is still performed today, though its prevalence has decreased dramatically compared to its peak usage. At its height in the late 2000s and early 2010s, the procedure accounted for a large fraction of all bariatric surgeries performed globally. However, by 2017, the frequency of new adjustable gastric banding procedures had fallen significantly, representing only about 3% of all annual bariatric operations in the United States.
The procedure now occupies a much smaller, specialized niche in the field of metabolic and bariatric surgery. It is sometimes considered for patients who have lower body mass indices or those who are unable to tolerate the higher risks associated with more invasive surgical options. The band’s main advantage is its reversibility and the fact that it involves minimal changes to the body’s natural anatomy. For some patients, it is viewed as a “bridge treatment” to initiate weight loss before a more definitive procedure might be considered or tolerated.
How Adjustable Gastric Banding Works
The adjustable gastric band is a silicone ring that is placed laparoscopically around the upper part of the stomach, creating a small pouch above the band and a much larger stomach below. This small pouch, which holds only a limited amount of food, slows the passage of food into the lower stomach, thereby inducing a feeling of fullness after eating small portions. Unlike other common bariatric procedures, the band is a purely restrictive device that does not involve any cutting, stapling, or rerouting of the stomach or intestines.
A key feature of the band is its adjustability, which is managed through a subcutaneous access port implanted just beneath the skin of the abdomen. This port is connected to the band by a thin tube, allowing a healthcare provider to inject or remove saline solution into the band’s inner balloon. Injecting saline inflates the balloon, tightening the band and increasing the restriction on the stomach opening. Removing saline deflates the band, which loosens the restriction and makes it easier for food to pass through.
The ability to adjust the band allows the surgeon to customize the level of restriction to the patient’s individual needs and weight loss progress. This outpatient process, often referred to as a “band fill,” regulates the amount of food a patient can comfortably consume. The device’s non-permanent nature means it can be removed completely, unlike procedures that involve permanent anatomical changes.
Long-Term Outcomes Leading to Decreased Use
The decline in adjustable gastric banding’s popularity stems from disappointing long-term results and high rates of complications requiring further intervention. Studies following patients for over a decade show that a significant percentage of patients do not maintain substantial weight loss compared to those undergoing other procedures. Many patients experienced weight regain over time, even with initial total body weight loss of about 16-20% at 10 to 15 years.
A major concern is the high probability of needing a reoperation due to device-related issues or insufficient weight loss. Long-term studies show that 36% to over 50% of patients require a second operation, often involving the band’s removal. The most common device-related complications include band slippage, where the stomach tissue moves through the band, and band erosion, where the device slowly migrates into the stomach wall.
Port-related problems, such as infection, tubing leaks, or displacement of the injection port, also contribute to the high reoperation rates. Issues like pouch dilation, where the small stomach pouch above the band stretches, and severe gastroesophageal reflux disease (GERD) are frequent reasons for band removal. This high rate of device failure and the need for frequent, specialized follow-up care ultimately made the procedure less cost-effective and less durable than anticipated.
Primary Bariatric Alternatives Today
The procedures that have largely replaced adjustable gastric banding as the standard of care are the Sleeve Gastrectomy and the Roux-en-Y Gastric Bypass. The Sleeve Gastrectomy, or Gastric Sleeve, is currently the most frequently performed bariatric surgery worldwide. This procedure involves surgically removing approximately 75-80% of the stomach, leaving behind a narrow, tube-like stomach.
The Sleeve Gastrectomy works by restricting food intake and by removing the portion of the stomach that produces much of the hunger hormone ghrelin, providing a hormonal effect. The Roux-en-Y Gastric Bypass is a more complex operation that combines restriction with malabsorption. It creates a small stomach pouch and then reroutes the small intestine to bypass a significant section, leading to fewer calories being absorbed.
The Gastric Bypass is often favored for patients with high body mass indices or those with severe obesity-related conditions, such as poorly controlled Type 2 diabetes or severe acid reflux. Both modern procedures demonstrate superior long-term results in terms of total weight loss and sustained resolution of comorbidities like diabetes and hypertension, explaining their current status as the preferred surgical options.