Laparoscopic Adjustable Gastric Banding

What is LAGB?

Laparoscopic adjustable gastric banding (LAGB) is a type of weight-loss surgery. Weight-loss surgery is also called bariatric surgery. It’s done as a laparoscopic surgery, with small incisions in the upper abdomen. The surgeon puts an adjustable band around the top part of the stomach. This creates a very small stomach pouch. The small stomach pouch means that you’ll feel full after eating less food. This will help you lose weight.

The band can be adjusted. This is done by adding or removing fluid in a balloon around the band. It is done through a port placed under the skin of your abdomen. A tube leads from the port to the band around your stomach. During office visits after surgery, your healthcare provider will use a needle to go through your skin into the port. Fluid is injected into the port. The fluid goes through the tube into the balloon around the band and squeezes the top of the stomach. A small amount of fluid is usually added at each office visit, while your weight loss is checked. If the band becomes too tight, some fluid will be removed. 

Why might I need LAGB?

LAGB is used to treat severe obesity. It’s advised for people who have tried other weight loss methods without long-term success. Your healthcare provider may advise LAGB if you are severely obese with a body mass index (BMI) over 40. Your healthcare provider may also advise it if you have a BMI between 35 and 40 and a health condition caused by obesity, such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.

What are the risks of LAGB?

Bleeding, infection, heart problems, lung problems, pain, wound issues, and blood clots in your legs are possible side effects that may occur after any surgery. General anesthesia may also cause breathing problems or other reactions.

Other risks of LAGB can include slipping of the band, puncturing of the stomach, or food not going into the stomach. You may have food intolerance after gastric band surgery. For example, you may not be able to eat red meat, a major source of dietary iron. This would put you at a higher risk for anemia. Over time, scar tissue can form around the stomach and band. This can make it hard to do any other surgery on the upper stomach later in life, if needed.

With LAGB, you may not lose as much weight as you would like. If your body mass index is over 50, the band might not be a good choice for you. If you are not physically active, you may not lose a lot of weight with the band.

You may have other risks based on your health. Make sure to talk with your healthcare team about any concerns before the surgery.

How do I get ready for LAGB?

Your healthcare team will need to make sure that LAGB is a good choice for you. Weight-loss surgery isn’t advised for people who abuse medicines or alcohol, or who are not able to commit to a lifelong change in diet and exercise habits.

Before having surgery, you’ll need to enroll in a bariatric surgery education program. It will help you prepare for surgery and life after surgery. You’ll have nutritional counseling. And you may have a psychological evaluation. You’ll also need physical exams and tests, such as a chest X-ray, blood tests, and an electrocardiogram. You may have imaging studies of your stomach, including an upper endoscopy. 

If you smoke, you will need to stop several months before surgery. Your surgeon may ask you to lose some weight before surgery. This will help make your liver smaller and make surgery safer. You’ll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines in the days before your surgery. Ask when they should be stopped and which medicines to continue. You shouldn’t eat or drink anything after midnight before surgery.

Before the surgery, you will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is unclear.

What happens during LAGB?

• LAGB surgery usually takes about 60 minutes.

• You will have general anesthesia for your surgery. This will cause you to be deeply sedated through the surgery and not feel pain.

• Your surgeon will use laparoscopy. They will make several small cuts (incisions) in your upper abdomen. They will then insert a laparoscope and put small surgery tools into these incisions.

• The surgeon will put an adjustable gastric band around your upper stomach and then tighten it to make a small stomach pouch.

• The surgeon will put a small port under the skin of your abdomen. A tube is connected between the port and the band.

• If you have a hiatal hernia, your surgeon may repair that at the same time as your LAGB surgery. 

What happens after LAGB?

You’ll likely go home the day after surgery. You will be on a liquid diet for the first week or two. Your surgery team will give you a schedule of types of meals over the next weeks. You’ll go from liquids, to pureed foods, then soft foods, and then to regular food. Each meal needs to be very small. You should make sure to eat slowly and chew each bite well. Don’t move too quickly to regular food. This can cause pain and vomiting. Work with your medical team to figure out what’s best for you to eat. After your stomach heals, you will need to change your eating habits. You’ll need to eat small meals for your small stomach. 

People who have weight-loss surgery may have trouble getting enough vitamins and minerals. This is because they take in less food and may absorb fewer nutrients. You may need to take a daily multivitamin, plus a calcium-vitamin D supplement. You may need additional nutrients, such as vitamin B-12 or iron. Your medical team will give you instructions.

You may also see changes in your bowel habits. Diarrhea is a common side effect, but constipation can also be a common problem after restrictive procedures, such as adjustable gastric banding. Ask your surgeon what changes you should expect and how to manage them.

You’ll need to have regular blood tests every few months in the year after surgery. This is to make sure you don’t have low blood iron (anemia), high blood glucose, or low calcium or vitamin D levels. If you have heartburn, you may need medicine to reduce stomach acid.

After losing weight, it’s possible to regain some of the weight that you lose. To prevent this, make sure to follow a healthy diet and get regular exercise. The gastric pouch may get wider (dilate) over time. It will let you eat more. But keep in mind that if you eat all you can, you can regain weight. You may want to join a weight-loss surgery support group to help you stick with your new eating habits.

You’ll need to have lifelong medical visits to make certain you are getting the nutrients you need, check for problems with the band, and have band adjustments as needed.

Next steps

Before you agree to the test or procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure