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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. This 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 doctor 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 doctor may advise LAGB if you are severely obese with a body mass index (BMI) over 40. Your doctor may also advise it if you have a BMI between 35 and 40 and a health condition such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.

What are the risks of LAGB?

Bleeding, infection, 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, a fibrous capsule to 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 option 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. This 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. You will need blood tests. You may have imaging studies of your stomach, or have 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. You shouldn’t eat or drink anything after midnight before surgery.

 

What happens during LAGB?

  • LAGB surgery usually takes 30 to 60 minutes.
  • You will have general anesthesia for your surgery. This will cause you to sleep through the surgery, and not feel pain.
  • Your surgeon will use laparoscopy. He or she will make several small cuts (incisions) in your upper abdomen. The surgeon 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 B12 or iron. Your medical team will give you instructions.

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 to medicine to reduce stomach acid.

After losing weight, it’s possible to regain some of the weight that you lose. To avoid this, make sure to follow a healthy diet and get regular exercise. The sleeve may widen (dilate) over time. This 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 life-long medical visits to check for problems with the band, and have band adjustments as needed.


 

Next steps

Before you agree to the test or the 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 will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure
Online Medical Reviewer: Brown, Kim, APRN
Online Medical Reviewer: Meilahn, John, MD
Date Last Reviewed: 10/1/2016
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