Laparoscopic gastric banding

You will receive general anesthesia before this surgery. You will be asleep and unable to feel pain.

The surgery is done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

• Your surgeon will make 1 to 5 small surgical cuts in your abdomen. Through these small cuts, the surgeon will place a camera and the instruments needed to perform the surgery.
• Your surgeon will place a band around the upper part of your stomach to separate it from the lower part. This creates a small pouch that has a narrow opening that goes into the larger, lower part of your stomach.
• The surgery does not involve any stapling inside your belly.
• Your surgery may take only 30 to 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a small amount of food. The food in the small upper pouch will slowly empty into the main part of your stomach.

Weight-loss surgery (also called metabolic and bariatric surgery or MBS) may be an option if you have moderate to high-risk obesity and have not been able to lose enough weight through diet and exercise.

Doctors often use the body mass index (BMI) and health conditions such as type 2 diabetes (diabetes that started in adulthood) and high blood pressure to determine which people are most likely to benefit from MBS.

Laparoscopic gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must diet and exercise after this surgery. If you do not, you may have complications or poor weight loss.

People who have this surgery should be mentally stable and not be dependent on alcohol or illegal drugs.

Be sure to discuss the benefits and risks with your surgeon.

This procedure may be recommended for the following people with obesity.

People with a BMI of 35 or more. Someone with a BMI of 35 or more is 80 or more pounds (36.3 kilograms) over their recommended weight. A healthy BMI is 18.5 to 24.9.

People who are Asian who have a BMI of 27.5 or more. Health risks in Asian people occur at a lower BMI than in non-Asian people.

People with a BMI of 30 to 34.9 (or a BMI of 25 or more in people who are Asian) who also have a serious medical condition that might improve with weight loss. Some of these conditions are:

• Obstructive sleep apnea
• Type 2 diabetes
• Asthma
• High blood cholesterol
• Nonalcoholic fatty liver disease
• Heart disease

Risks for anesthesia and any surgery include:

• Allergic reactions to medicines
• Breathing problems
• Blood clots in the legs that may travel to your lungs
• Blood loss
• Infection, including in the surgery site, lungs (pneumonia), or bladder or kidney
• Heart attack or stroke during or after surgery

Risks for gastric banding are:

• Gastric band erodes through the stomach (if this happens, it must be removed).
• Stomach may slip up through the band. (If this happens, you may need urgent surgery.)
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers.
• Infection in the port, which may need antibiotics or surgery.
• Injury to your stomach, intestines, or other organs during surgery.
• Poor nutrition.
• Scarring inside your belly, which could lead to a blockage in your bowel.
• Your surgeon may not be able to reach the access port to tighten or loosen the band. You would need minor surgery to fix this problem.
• The access port may flip upside down, making it impossible to access. You would need minor surgery to fix this problem.
• The tubing near the access port can be accidentally punctured during a needle access. If this happens, the band cannot be tightened. You would need minor surgery to fix this problem.
• Vomiting from eating more than your stomach pouch can hold.

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• Blood tests and other tests to make sure you are healthy enough to have surgery.
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur.
• Complete physical exam.
• Nutritional counseling.
• Visit with a mental health provider to make sure you are emotionally ready for major surgery. You must be able to make major changes in your lifestyle after surgery.
• Visits with your provider to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control.

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk for problems after surgery. Tell your provider if you need help quitting.

Always tell your provider:

• If you are or might be pregnant
• What medicines, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask which medicines to take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything for 6 hours before your surgery.
• Take the medicines your provider told you to take with a small sip of water.

Your provider will tell you when to arrive at the hospital.

You will probably go home the day of surgery. Many people are able to begin their normal activities 1 or 2 days after going home. Most people take 1 week off from work.

You will stay on liquids or mashed-up foods for 2 or 3 weeks after surgery. You will slowly add soft foods, then regular foods, to your diet. By 6 weeks after surgery, you will probably be able to eat regular foods.

The band is made of a special rubber (silastic rubber). The inside of the band has an inflatable balloon. This allows the band to be adjusted. You and your doctor can decide to loosen or tighten it in the future so you can eat more or less food.

The band is connected to an access port that is under the skin on your belly. The band can be tightened by placing a needle into the port and filling the balloon (band) with water.

Your surgeon can make the band tighter or looser any time after you have this surgery. It may be tightened or loosened if you are:

• Having problems eating
• Not losing enough weight
• Vomiting after you eat

The final weight loss with gastric banding is not as large as with other weight loss surgery. The average weight loss is about one-third to one-half of the extra weight you are carrying. This may be enough for many people. Talk with your provider about which procedure is best for you.

In most cases, the weight will come off more slowly than with other weight loss surgery. You should keep losing weight for up to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have, such as:

• Asthma
• Gastroesophageal reflux disease (GERD)
• High blood pressure
• High cholesterol
• Non-alcoholic fatty liver disease
• Sleep apnea
• Type 2 diabetes

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your provider and dietitian gave you.

Lap-Band; LAGB; Laparoscopic adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding; Obesity - gastric banding; Weight loss - gastric banding

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Updated by: John E. Meilahn, MD, Bariatric Surgery, Chestnut Hill Surgical Associates, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.