Obesity is a growing concern. By medical standards, obesity is defined as having a body mass index (BMI) of over 30 kg/m2. While lifestyle modification remains the cornerstone for treatment, surgical options are becoming more popular. One of the surgical treatments for obesity is called lap gastric band surgery, commonly known as lap-band surgery.
What is gastric banding?
Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach using a laparascope. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin of the abdomen. This port is used to introduce or remove saline into the band.
What is a lap band?
The LAP BAND is a specific device brand name. The term is often used in the lay community interchangeable with gastric banding. There are different sizes and models of the LAP BAND. There are also other companies that make gastric banding devices such as the REALIZE adjustable gastric band (by Ethicon), the MIDBAND, and the Heliogast gastric band.
Who are candidates for the lap band system?
Generally, candidates for LAGB have a body mass index over 40 kg/m2, or are more than 45 kilograms over their ideal body weight. LAGB can be performed on a person with a BMI of 35-40 kg/m2 if there are problematic medical conditions that are weight-related, such as high blood pressure (hypertension) or diabetes.
Most surgeons and programs will want to note a history of failed weight loss in the past using more conventional approaches. The procedure is indicated for adults only, and is not to be performed on those less than 18 years old. All patients must demonstrate an understanding of the procedure, and be willing to adhere to the lifestyle changes that are needed to make this procedure successful. Most large centers have a psychological assessment to assure that this last criteria is met.
LAGB is usually contraindicated if the potential patient has difficulty understanding the procedure, is emotionally unstable, or is dependent on drugs or alcohol. Those potential cases with a history of gastrointestinal problems such as ulcers need to be reviewed carefully. Similarly, those that have underlying medical conditions that make them high risk for surgery- such as heart or lung conditions- may be refused the procedure. Associated with these risks is a BMI of greater than 50kg/m2. In this group, there may be a request to lose weight prior to the procedure (although this seems paradoxical). Again, the risks of the procedure in this subgroup of obese patients may outweigh the benefits of surgery. By dropping the BMI under 50 kgm2, outcomes may be better.
How is the lap band (LAGB) procedure performed?
Lap band or LAGB is a surgical procedure done under full general anesthesia and takes about 1 to 2 hours to perform. It is done using a laparoscopic technique. This involves making 3 to 5 small incisions, each about 1 inch in length. The surgeon inserts a small camera attached to a tube into one of these incisions and views the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band. The gastric band is placed around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.