LAP BAND

The adjustable gastric band was FDA-approved in 2001 for people with a body mass index (BMI) of at least 40 (or 30 if you have a documented, weight-related medical condition or comorbidities that are known to improve with weight loss, such as diabetes, sleep apnea, or high blood pressure) who have tried other weight-loss programs without success. 

To be a good candidate, you'll need to be mentally ready to make lifestyle changes to ensure the long-term success of this weight-loss procedure and avoid future weight regain.

Pros

• The rate of complications after the surgery is relatively low, compared to other bariatric procedures. The American Society for Metabolic and Bariatric Surgery (ASMBS) reported in 2012 that the 30-day mortality rate for lap band surgery was 0.03%, compared to 0.08% for sleeve gastrectomy and 0.14% for gastric bypass. 
• There's also a low risk of developing vitamin and mineral deficiencies, so you won't have to take daily vitamins as you would after a procedure like gastric bypass.
• It's an outpatient procedure, so you'll go home the same day.
• It doesn't require the stomach or intestines to be surgically divided, so you'll only need about 1 week of downtime (vs. up to 2 weeks after gastric sleeve surgery and up to 3 weeks after gastric bypass) before you can start returning to your daily activities.
• Lap band removal is possible, if you have a complication or decide you no longer want it

Cons

• Weight loss with a lap band is slower and less dramatic than you'd experience with some other kinds of weight loss surgery. For this reason, gastric bands have fallen out of favor over the past decade.
• During the first year, you may need to return for monthly office visits and lap band adjustments. 
• The silicone band is a foreign object, and there is a small risk that the band will erode the surrounding stomach tissue over time. 
• Other risks include band slippage (which is rare, but could require lab band revision surgery), problems swallowing due to enlargement of the esophagus, and difficulty with food passing through the small opening. 
• Vomiting, constipation, and acid reflux are common issues that can negatively impact your quality of life, even though they're not necessarily dangerous.

Many (but not all) health insurance plans cover obesity surgery and bariatric procedures, including lap band surgery. Some even cover the cost of surgery to remove excess skin. 

Check with insurance carrier to see what level of coverage they offer and whether you'll need to document weight-related health issues that would make the surgery medically necessary. They may also require proof of a series of weight management visits before you can qualify.

Lap band surgery is performed laparoscopically (through several incisions less than 1 cm long), so it’s minimally invasive—but it still requires general anesthesia. The procedure typically takes less than 45 minutes.

With laparoscopic adjustable gastric banding, your surgeon makes a few small incisions on your belly to allow access for a camera, the lap band, and long, thin surgical instruments. 

They then insert the lap band into your abdominal cavity and wrap it around your stomach, an inch or two below where it meets your esophagus. 

Tightening the band around your stomach, your surgeon makes a holding pouch that’s much smaller than your whole stomach.

Then they fill the lap band with enough saline fluid (salt water) to snugly hold the band in place, while leaving enough of an opening for food to slowly exit the small pouch and make its way into your full stomach for normal digestion (so there's no risk of malabsorption, as in the case of a duodenal switch, another type of weight loss surgery). 

They’ll also set up an access port under your skin to allow for additional surgeries, to make adjustments in the future.

You should be able to go home the same day, once you recover from the anesthesia. Make sure you have someone there to take you home.

Surgeons recommend taking a week off work after lap band surgery. Expect to be uncomfortable—but not in an excessive amount of pain—during the first couple of days, says New York bariatric surgeon Dr. David Buchin. Most people begin to feel back to normal after three or four days.

You’ll need to follow a strict diet for the first six weeks after gastric band surgery, beginning with liquids and gradually introducing soft foods before resuming a normal diet (with smaller portions). 

Because of the space restriction in your stomach, you’ll have to relearn your eating habits to feel comfortable. You may experience vomiting and acid reflux as you adjust.

The ideal pace of weight loss after lap band placement is one to two pounds per week, says Ontario bariatric surgeon Dr. Christopher S. Cobourn in a RealSelf Q&A. 

Significant weight loss is possible over time, particularly if you watch your food intake and stick with a regular exercise program. A systematic review of the Lap-Band System in the United States found that the average weight loss over 20 years was 66.4 lbs (30.1 kg).

The pattern of weight loss is slow and steady, but if you notice a plateau—especially if it corresponds with an increase in hunger and a feeling that you can eat more than you should—that may mean your lap band needs to be adjusted. Your surgeon can add or remove saline from the lap band, via your port, to reposition it.

Lap band placement is permanent unless complications arise, so expect to see your doctor for regular adjustments. 

You’ll need an ongoing relationship with your provider to manage the device and your weight-loss program.

Complications from lap band surgical procedures are relatively common, though typically not dangerous. 

They include constipation, nausea, vomiting, acid reflux, and food being unable to pass through the small pouch opening. See your doctor for an adjustment if you’re having difficulties. Another risk is that the lap band could slip, and revision surgery may be needed.

It's not usually an emergency. Symptoms of gastric band slippage include heartburn, painful eating, vomiting, coughing (especially at night), and chest pain or pressure.

“Fortunately, band slippage is rare, occurring in only 2–3% of patients,” says Los Angeles bariatric surgeon Dr. Babak Moeinolmolki in a RealSelf Q&A. “Sometimes removing fluid from the band will allow the stomach to adjust and the symptoms to resolve. If fluid adjustment does not resolve the symptoms, conversion to the sleeve gastrectomy or gastric bypass surgery is usually recommended.”