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Laparoscopic Adjustable Gastric Banding (LAGB)

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Procedure –

It is one of the most popular restrictive bariatric surgeries in western countries. In this an inflatable silicon band is wrapped around the upper part of stomach just below the junction of esophagus and stomach. Capacity of stomach above this band will be < 20 ml. So patient can’t take large quantity of food at a time. This band has a balloon which is connected through a tube to an access port fixed outside abdominal muscles. By injecting or withdrawing saline from the access port, connection between the pouch and remaining stomach can be adjusted there by controlling the food intake. If weight loss is not satisfactory band is tightened by injecting some saline through access port. If patient is not able to take food or develops food intolerance, some saline is withdrawn from the band through port. This is an attractive restrictive operation as it is easy to perform, takes less time (less than 1 hr), complications are very few and hospital stay is very short (less than 1 day). Problem with this operation is the need for regular visits to the doctor for repeated adjustments of the band. Because of this reason this is not popular in India. This operation has no control over the amount of liquid food that is taken. So few patients develop maladaptive food habits and start consuming lot of liquid food so that they will regain weight.

Laparoscopic Adjustable Gastric Banding  (Drawn by Dr. V. Amar)

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Complications –
Laparoscopic adjustable gastric banding is safe if it is performed on the right candidate properly. But problems do occur in a small percentage of patients. They are related either to the anesthesia, surgery or postoperative management. After this operation food intolerance, band slippage, band erosion, pouch dilatation or gastric prolapse can occur. Band slippage has been reduced to less than 5% after pars flaccida technique has been implemented for the placement of band. Ineffective weight loss, inability to sustain weight loss and operation failure are problems associated with restrictive operations in certain small percentage of patients. Compared to restrictive + mal-absorptive operations and mostly mal-absorptive operations vitamin and mineral deficiencies are less likely after LAGB. But these deficiencies can still occur due to reduced food intake. So, lifelong supplements are prescribed even after LAGB.

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