Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Obesity is a growing concern. Recent statistics show that 30% of Americans
meet the criteria for obesity. 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 gastric banding,
commonly known as lap-band surgery. Some of the specifics
of gastric banding will be addressed in this article.
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. 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 in the abdomen. This port is
used to introduce or remove saline into the band.
LAGB ultimately restricts the
size of the stomach and the amount of food it can hold. It also slows the
passage of food to the intestine. By doing so, signals to the brain from the gut
allow for a sensation of fullness and satiety with the consumption of less food.
What is a lap band?
The LAP BAND® is a specific device brand name and is made by Allergan
Inc. The term is often used in the lay community interchangeable with gastric
banding (similar to the way we interchange the brand name Kleenex for facial
tissue). 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 (which are not
available in the US).
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 medical problems that are weight-related, such as
high blood pressure (hypertension) or
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. Many 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 kg.m2, outcomes may be better.
While there is growing discussion about offering LAGB to those with a BMI of
30-35 who have diabetes, there are no current guidelines to allow for this.
Considering Gastric Bypass Surgery? Important Questions to Ask Yourself
Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: Jay W. Marks, MD
Bariatric surgery refers to surgery performed on the
stomach and/or intestines to decrease the amount of food that can be consumed
and, as a result, to help a person with extreme obesitylose weight. Adjustable
gastric banding and gastric bypassare the two main types of bariatric surgery.
In adjustable gastric banding, a reversible procedure, insertion of a band restricts the size
of the opening from the esophagus to the
stomach. The size of the opening to the stomach determines the amount of food
that can be eaten. Gastric bypass is a permanent reduction in the size of the
stomach in which a small pouch is created from the proximal portion of the
stomach and attached to the intestine in a location that bypasses about 2 feet
of normal intestine. The amount of food that
can be eaten is limited by the size of the pouch and the size of the opening
between the pouch and the intestine.
If you're interested in bariatric surgery (gastric bypass or gastric banding), the following questions can help
you decide if this type of procedure might be of benefit for you.
How much weight do you need to lose? Bariatric surgery is an option for
people who have a body mass index(BMI) above 40, indicative of extreme obesity.
Bariatric surgery may also
be considered for people with a BMI between 35 and 40 who have health problems
like type 2 diabetesor heart disease.
tried other weight lossmethods, such diets and exercise, without success? Have
you tried such methods repeatedly? Bariatric surgery is considered a last-resort
solution for people who are unable to lose weight by any other means.
have a serious medical condition? Some people with serious heart or lung
conditions may not be a good candidate for surgery.