Gastric banding or lap banding—short for laparoscopic gastric banding—is a type of minimally invasive surgery to assist in weight loss, which involves placing a soft, adjustable silicone band around the top part of the stomach to create a small upper pouch.

Once in place, the band limits the volume of food that can be consumed at any given time. When eating, food collects in the upper pouch of the stomach, leading to a feeling of fullness, making people eat much less. The food that collects in the pouch slowly empties itself into the larger stomach area.

Over 350,000 metabolic or obesity procedures are performed worldwide. Around 220,000 of them are in the US. [1] Lap banding is the most sought after weight loss procedure in Australia with over 11,000 procedures annually. Lap Band (also known as Swedish Adjustable Gastric Band – SAGB) is one of the brands used in gastric banding by Australian surgeons.

Reasons for choosing to have gastric banding

The surgical band placed around the stomach is adjustable; allowing flexibility in how much food can be eaten, it is also removable, at which point the stomach can return to its normal size. Little downtime is needed to recover from this procedure. Because gastric banding does not involve cutting or removal of any part of the digestive tract, as is the case with some other types of weight loss procedures, it does not lead to nutritional deficiencies. The procedure is permanent, until the band is removed.

Weight loss with a gastric band is not as drastic as that achieved with more invasive procedures. However, a study of over 2,900 patients who had an average BMI of 45.3 showed that gastric bands helped achieve a substantial and sustainable weight loss of around 50 percent of excess weight, when measured six years following surgery. This level of weight loss falls safely within the US National Institute of Health recommendation for weight loss of half to one kilogram per week.

Gastric banding is not a quick fix; nor is it an option for people who are not prepared to change their lifestyle habits. An extensive screening process is required to establish whether or not you qualify for the procedure.

Weight loss surgery such as gastric banding is an option for people who have been severely obese for five years or more, and have tried and failed to lose weight through diet and exercise. Before you undergo gastric banding, you need to understand its risks and limitations and be committed to making lifestyle and dietary changes. If you don’t, you may have serious complications from the surgery as well as minimal weight loss. You may also be required to participate in long term follow up programs that will monitor your nutrition, behaviour, lifestyle and medical conditions.

A person’s “body mass index” (BMI) is a key indicator in deciding whether that person is obese and whether he or she should undergo weight loss surgery. BMI in adults is calculated using weight and height.

Anyone with a BMI below 18.5 is considered underweight. You are within a healthy weight range if your BMI is between 18.5 and 24.9. Those who fall within the 25 to 29.9 ranges are considered overweight. Those with a 30 or higher BMI are obese while a BMI above 40 is considered morbidly obese.

You are a candidate for gastric banding if

• You have a body mass index (BMI) of 30 or higher;
• Your BMI is 30 or above, and you have associated health problems including high blood pressure, heart disease, severe sleep apnea, type 2 diabetes, and degenerative joint problems. Infertility due to polycystic ovary syndrome (PCOS) is also a qualifying medical reason for weight loss surgery.

Mental stability is a consideration in assessing suitability.

Benefits of banding extend beyond losing excess weight and resolving associated complications. Extremely obese adults not only achieve better physical health one year after surgery, but also have the benefit of improved psychological health. Having one food-conscious family member, often the woman of the house or the mother, is known to improve the diet and nutrition in the whole family. This applies to other weight loss surgeries as well.

You are not a good candidate for gastric banding if

• You are dependent on illegal drugs or alcohol.
• You suffer from an inflammatory disease of the gastrointestinal tract.
• You have a severe heart or lung disease.
• You have an anatomically distorted oesophagus, stomach, or intestine.
• You are pregnant. Falling pregnant after surgery is not a problem, but is not advised at the time of surgery.
• You live in a remote area with little access to medical care.

What to expect

The gastric banding procedure takes about an hour to complete. It is normally performed under a general anaesthetic; you will not feel any pain during or after surgery.

The procedure is called laparascopic surgery, as opposed to open surgery, because it is performed using small incisions and a tiny camera called a laparascope. Fitting the gastric band is achieved using the viewing tube attached to the camera and other tiny instruments that are inserted inside the body through these incisions. Some surgeons are able to perform the procedure with just a single incision.

The band is inserted into the body, placed around the upper part of the stomach and locked into place. It is then secured with sutures and a port, which enables the surgeon to make subsequent adjustments to the band.

Band fills

The band can be tightened or loosened by filling or emptying the port, which alters the size of the passage between the small stomach pouch and the stomach. This procedure is called a “fill”. The port is usually left empty in the first four to six week period following surgery to allow your stomach to heal.

Your first fill, or the first adjustment, will typically be six weeks after surgery. Most people have no issues with the band until the first fill, and report that they can eat normal amounts of food and even feel hungry.

The fill is a quick and painless adjustment to the band that takes place during a routine visit to the surgeon’s office. Fills help people achieve consistent weight loss.

Your lap band needs ongoing adjustments and may need future maintenance.

It is possible to reverse the procedure.

Before and after surgery

There are things you can do leading up to any kind of surgery to improve the experience.

If you are ready and able to make major lifestyle changes, a gastric banding procedure can improve your life significantly. Preparation for the procedure includes getting used to making lifestyle and dietary changes necessary to achieve the best results from the surgery. Some changes need to begin before the procedure—like getting used to a new way of eating—and it is best to follow your surgeon’s instruction on this.

Here are the basics, which may be part of your surgeon’s instructions:

• Begin by eating several small but balanced meals (as opposed to a few large meals a day) in the weeks leading up to the surgery. That way, post surgery diet changes will not be difficult. This is a good practice even for those without a lap band.
• Eat very slowly; take small bites; chew your food thoroughly, especially after the surgery.
• Remember that certain foods are not tolerated by the lap band, including those with a doughy consistency, and overcooked or dry meat.
• Stop eating when you feel full. Feeling full sooner is one great advantage of the lap band.
• To reduce potential discomfort and vomiting, avoid eating and drinking at the same time.
• Cut down on snacking between meals.
• Drinking at least six to eight glasses of water daily, in small sips, will help you avoid dehydration and associated problems such as constipation. You can drink low calorie non-carbonated drinks, but water is best for your health and hydration.
• If you smoke, quit well ahead of the surgery. Smoking reduces your body’s ability to heal and can lead to complications. Read our article on smoking and surgery for more information.
• If you do not have a regular exercise routine, start a moderate exercise program if your health permits.
• If you want to lose some weight before surgery, go ahead. Losing between five and ten percent of your body weight before surgery will lead to a shorter hospital stay. It will also make losing the remaining weight easier.
• When your surgeon discusses the preoperative instructions with you, make sure to disclose all medications, vitamins, minerals and supplements you are currently taking. Some may lead to problems during or after surgery. You should not stop taking medications without asking the doctor who prescribed them first.

There are a number of things you can do following any surgery.

After surgery, closely follow your surgeon’s and clinics instructions on diet, exercise and band maintenance. They may help you deal with such potential complications as dehydration, nausea and vomiting, and help you maintain your weight reduction on schedule. It is possible to gain weight after any weight loss procedure. The lifestyle changes you make, your motivation, and the amount of exercise you take will determine the success of your surgery.

Possible risks and complications

As with any surgical procedure there are risks involved in gastric banding. You should be fully aware of these before you elect to have the procedure.

Make sure you familiarise yourself with the list of complications that could arise as a result of any surgery. This includes bleeding, infections and complications from anaesthesia.

Recent studies show that complications arise in about 12 percent of patients. Specific complications that may occur after a gastric banding procedure:

• Band slip is one of the most common complications, occurring in about 4.5 percent of patients. Some people experience nausea and vomiting after the surgery. Band slip may occur with persistent vomiting.
• Port related problems occur in less than 4 percent of patients.
• Band erosion, where the band erodes into the inside of the stomach, is rare and occurs in less than 0.2 percent of patients.
• Weight gain, and the need for a repeat of the procedure.
• Spontaneous deflation of the band may occur due to leakage.
• Enlargement of the stomach pouch.
• Blockage of the stomach outlet.
• Ulceration.
• Gastritis (irritation of stomach tissue).
• Gastro oesophageal reflux.
• Heartburn.
• Bloating.
• Difficulty in swallowing.
• Dehydration.
• Constipation.
• Weight-loss surgery may put you at a higher risk of developing gallstones.

Some patients who undergo this procedure may face unique complications that need to be recognised and managed properly in order to achieve good outcomes. The best way to reduce risk in any surgery is to find a surgeon who is fully qualified, has received formal training in surgery and has performed the procedure many times.

Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you. Your surgeon can also advise you on how to avoid or minimise some types of risk.

Rough costs involved

The cost of a gastric band procedure may vary depending on the surgeon, where you have the surgery, your weight and related health issues, and whether or not you have insurance. With the right combination of health insurance and surgeon, your procedure can cost around $3500 (AUD). However, if you do not have private insurance, out of pocket costs may amount to as much as $14,000 (AUD).

Your surgeon is the best source for additional information in this regard. Some even offer easy payment and other financing schemes.

You should expect the costs to be higher if you are having combined procedures at the same time.

This information is correct as of 2019.