Laparoscopic gastric banding (LGB) operations

The adjustable gastric band (LAP-BAND and its variants) is the most common form of weight loss surgery carried out in the UK and is usually performed laparoscopically (keyhole surgery). It is one of the least invasive approaches to obesity because neither the stomach nor the intestine is cut.

The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits. The gastric band can help you achieve longer-lasting weight loss by:

• limiting the amount you can eat
• reducing your appetite
• slowing digestion

How the band works

There are various types of LGB, but essentially they involve placing a hollow silastic band around the upper part of the stomach. This band divides the stomach into a small upper pouch above the band and a larger pouch below the band. This small gastric (stomach) pouch limits the amount of food that a patient can eat at any one time, and will result in a feeling of fullness after eating a small amount of food. LGB is classed as a “restrictive” procedure, ie it restricts the amount of food passing into the main body of the stomach. Gastric bypass, on the other hand, relies on both restriction and malabsorption (see below).

How long does it take to do LGB surgery?

The procedure itself takes 30-45 minutes, on the average, but allowing for the time involved in administering the anaesthetic etc, the total time in theatre is about 1 hour.

How long will I be in hospital?

Assuming things go well, you will be in hospital overnight and discharged the following day.

Adjusting the Band

By injecting fluid (saline) into the hollow band, the size of the opening between the upper and lower parts of the stomach can be tightened to reduce the amount of food passing from the upper part of the stomach to the lower. Conversely, if fluid is removed the band is relaxed, the opening is larger and hence more food is allowed to pass from the small pouch above the band, into the main body of stomach below. The band is connected by a tube to a reservoir placed beneath the skin during surgery, usually at the lower end of the breast bone. The surgeon or Nurse Practitioner can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle.

Risks of LGB

In general the risks associated with LGB are very small, with published mortality rates as low as 1 in 2000. Additional complications include band slippage, tube rupture/disconnection, abscesses, gastric erosion, pouch dilation and port infection. However, in general the benefits greatly outweigh the relatively small risks involved.

Benefits of LGB

Because the band is adjustable, removable and does not require permanent alteration to the anatomy of the stomach or intestines, LGB provides an option for patients who may not otherwise consider surgery for treatment of their obesity. Other advantages include a shorter hospital stay and the surgery has no effect on food and nutrient absorption through the intestines.

Weight is lost during the first 2 to 3 years after surgery and follow-up data indicates 50-60% excess weight loss at 5 years. Importantly, this weight loss translates into dramatic improvements in weight-associated co-morbidities. Patients report improvements in mood, mobility, exercise capacity and sleeping patterns. Blood pressure and cholesterol levels are reduced and the majority of Type 2 diabetics are cured.

Due to the relative safety of the procedure, the adjustability and reversibility of the band and the impressive health benefits, LGB is increasingly regarded as the optimal initial approach for the control of obesity and associated medical conditions.

Additional information