Gastric band surgery, or Lap-Band® surgery, is a type of weight-loss (bariatric) surgery that helps some patients with obesity lose weight. Doctors place an adjustable silicone belt (or band) around the upper portion of the patient’s stomach, dividing it into two sections. Patients feel full sooner than they would without a band restricting their stomach size.

The adjustable band surgeons wrap around the stomach creates a small upper pouch that’s only a fraction of the size of the entire stomach. When a patient eats, food enters this small pouch. When it fills up, the patient feels full. The procedure encourages those with obesity to consume less food over time, leading to gradual weight loss.

Gastric band surgery is a relatively simple procedure compared with other types of bariatric surgery. The gastric band is adjustable, enabling doctors to loosen or tighten it after surgery to help patients lose weight most effectively.

Gastric band surgery or other bariatric procedures may be recommended to patients with obesity who have been unable to lose weight through diet, exercise, and other non-surgical interventions, including medications. (Patients do not need to specifically try or fail anti-obesity medications to be eligible for bariatric surgery.) A psychiatrist evaluates patients to see if they are mentally prepared to undergo gastric band surgery, for which they’ll need to eat differently for the rest of their lives. (Despite feeling full, some people may continue to overeat or have other symptoms of disordered eating.)

The “Lap-Band” is the only brand of gastric band that is currently available in the U.S.; it was approved by the Food and Drug Administration (FDA) in 2001. Gastric band surgery may lead to complications that require follow-up procedures (more on that below).

Patients who have gastric band surgery are expected to lose around 15% of their total body weight within a few years but may have a high rate of reoperation and/or removal.

Gastric band surgery is a procedure during which surgeons encircle the upper portion of the stomach with a soft, flexible band that restricts the amount of food that can enter the stomach. The band creates a small pouch in the upper stomach that makes patients feel satiated when it becomes filled. Patients with obesity begin to eat less over time, which helps them lose excess body weight.

After gastric band surgery, patients visit the doctor several times per year so that the doctor can make their band looser or tighter, depending on their needs. The band is filled with saline, and doctors can add or remove saline during office visits (more on this below). Adding more saline makes the band tighter, while removing saline makes the band looser. Loosening or tightening the band controls how quickly or slowly food moves from the small pouch created in the upper stomach to the rest of the stomach; it does not change the location of the gastric band or the size of the small pouch in the upper stomach. Adjusting how quickly or slowly food moves is important—those with too loose a band may not experience significant weight loss. Others with too tight a band may experience nausea and vomiting.

Gastric band surgery is a laparoscopic procedure: Surgeons make small incisions in the abdomen through which they insert their tools and a camera. It is performed under general anesthesia.

During the procedure, surgeons place an adjustable silicone band around the stomach’s upper portion. The interior of the band contains a balloon filled with saline. A short tube with a port at the end of it is attached to the balloon within the gastric band. The port is positioned beneath the patient’s skin in the upper abdomen.

After surgery, doctors can access the port via a syringe to add or remove saline as needed, enabling doctors to adjust the band’s tension. Patients who don’t lose the expected amount of weight may need to have their bands tightened. Other patients who experience eating difficulties or who vomit after eating may need to have their bands loosened.

When the gastric band has the correct tension, a patient will feel satiated after eating a small meal. Food gradually moves from the small upper pouch of the stomach to the lower portion, then to the intestines.

Patients must consume a liquid diet for two to three weeks after surgery. They gradually incorporate more food into their diet until there are no restrictions, and they are able to eat normally again.

After having gastric band surgery, patients must chew their food extremely well to make it easier for food to enter the stomach and pass by through the band. Patients may be told to eat six small meals per day, rather than three larger meals. Mealtime beverage intake should also be restricted so that patients won’t fill up on liquids.

Patients who follow their doctor’s advice may lose about 15% of their total body weight within a few years.

Gastric band surgery is offered to treat patients with obesity. A body mass index (BMI) calculation, comparing a patient’s height and weight, helps doctors determine whether a patient has obesity. To be considered obese, the BMI should be 30 or higher.

Patients with obesity who may be eligible for gastric band surgery include:

• Those with a BMI of 40 or higher
• Those with a BMI of 35 or higher with at least one chronic health condition related to obesity, including type 2 diabetes and high blood pressure
• Those with a BMI between 30 and 35 who have at least one chronic health condition related to obesity and who have been unable to control their weight through non-surgical approaches

Because it does not reroute the digestive process, gastric band surgery has a very low risk of causing malnutrition or vitamin deficiency in patients, which can occur with certain other types of bariatric surgery. And unlike with sleeve gastrectomy (another type of weight-loss procedure), gastric band surgery is completely reversible if complications do arise.

In the U.S., very few doctors offer gastric band surgery. It is much less widely used than sleeve gastrectomy and gastric bypass surgery because gastric banding often requires follow-up surgery to manage complications that arise. Gastric banding results in need for reoperation and/or removal in around 50% of patients.

Additionally, other bariatric procedures may lead to greater weight loss than gastric band surgery.

The following risks are associated with gastric band surgery:

• Bleeding or infection. Patients may experience bleeding or infection after gastric band surgery. These complications may arise after any type of surgery. Infection may also arise at the port site.

• Band slippage. In some patients, the gastric band slips out of place over time. When this happens, an additional procedure is needed to put it back in place. If the slippage causes swelling, doctors may remove the gastric band for six weeks to allow the swelling to subside before placing the band again.
  
• Band erosion. In some patients, the gastric band cuts through the stomach’s exterior into its delicate inner lining, where it can cause damage. Additional surgery is necessary to correct this problem, which is known as gastric band erosion.

• Stomach Enlargement. Sometimes, the small upper stomach pouch may become enlarged, enabling patients to overeat and gain weight. The enlarged upper pouch may also lead to discomfort associated with eating, including heartburn, trouble swallowing, or vomiting. Temporarily removing saline from the gastric band may relieve symptoms. Otherwise, follow-up surgery may be needed to relocate the band.

• Band malfunction. Occasionally, gastric band equipment malfunctions. The balloon or tubing that holds saline may become punctured, or the tubing may become twisted. Doctors may be able to locate and repair a leak with imaging tests in an office procedure, but this isn’t always possible. Sometimes, the entire banding system needs to be replaced.

• Bowel obstruction. If the gastric band or tubing becomes entangled with the intestines, the bowels may become partially or completely obstructed, which is a serious condition that must be resolved promptly. Surgery can correct this problem. Shortening the tube should help to prevent future instances of bowel obstruction.

• Gastroesophageal reflux disease (GERD). Some patients develop GERD, a condition in which stomach acid flows back into the esophagus.

This article was medically reviewed by Neil Floch, MD, a Yale Medicine bariatric surgeon and director of Bariatric Surgery at Greenwich Hospital, and John Morton, MD, MPH, MHA, medical director of Bariatric Surgery for the Yale New Haven Health System.