© Springer International Publishing Switzerland 2017Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_14
14. Laparoscopic Gastric Band: Pros and Cons
Department of General Surgery, Rowan University, Stratford, NJ, USA
There are several positive and negative aspects associated with the laparoscopic adjustable gastric band (LAGB) listed below:
It is a minimally invasive procedure.
Shorter hospital stay.
Does not require partial removal of the stomach or diversion of the gastrointestinal tract.
Purely restrictive, therefore does not cause malabsorption.
The only procedure that allows for outpatient adjustments after surgery.
Demonstrates improvement in obesity-related comorbidities.
Can be applied to obese adolescents.
Strict diet and lifestyle modifications are required to achieve and maintain weight loss.
Less effective weight loss than other bariatric procedures.
May require revision or conversion to another weight loss procedure.
Let’s expand on these further.
Almost all surgery for obesity is now performed laparoscopically through several small incisions making it minimally invasive. However, the LAGB has shown to impart a shorter hospital stay and shorter operative time than other minimally invasive weight loss procedures .
Procedures can be divided into restrictive and malabsorptive. The benefit of LAGB is that it does not require diversion of the gastrointestinal tract like laparoscopic Roux-en-Y gastric bypass or removal of a portion of the stomach like laparoscopic sleeve gastrectomy. Furthermore, the LAGB is considered a purely restrictive procedure in which patients are less likely to have malabsorption .
The LAGB is unique in that the band has an inflatable balloon attached to a subcutaneous port. This allows for outpatient adjustments in band volume without having to hospitalize the patient. In this way, patient weight loss can be tailored .
Like other weight loss procedures, patients will have an improvement in obesity-related comorbid conditions like diabetes, hypertension, and hyperlipidemia. Approximately two-thirds of patients with diabetes can achieve better glucose control or complete resolution of diabetes after LAGB. One study showed improvement in hypertension in up to 80 % of their subjects, with 55 % no longer requiring any antihypertensive medications. Furthermore, the LAGB has had a positive impact on illnesses like obstructive sleep apnea, gastroesophageal reflux disease, and asthma .
There are various criteria that need to be met prior to undertaking bariatric surgery. The majority of procedures today are only performed in adults who have a BMI > 35 with comorbid conditions or those with BMI > 40. Furthermore, this procedure is being performed in obese adolescents and has shown positive results similar to adult studies [5, 6].
In post-gastric band, patients are required to have a lifelong follow-up with their surgeon and a close follow-up with a dietitian. Lifestyle and diet modifications are integral parts of success with LAGB and maintenance of weight loss .
Patients can achieve between 34.7 and 53.3 % of EBW in 1 year. However, multiple studies have shown non-LAGB procedures such as gastric sleeve and Roux-en-Y gastric bypass to have superior weight loss .