The most commonly performed procedure worldwide for obesity is laparoscopic placement of the adjustable gastric band (Lap Band).  The Australians have extensive experience using this method and have provided tremendous insight as to techniques and post operative management.  This procedure takes approximately one hour, with a 23 hour inpatient hospital stay.

The Lap Band procedure is a purely "restrictive" procedure.  That is, when the fit of the band is optimal, patients will be restricted to the amount that he or she can eat at any one time and allow the patient to feel satisfied after eating only a very small amount of food.  The true secret of the Lap-Band is that it takes away your hunger.  The Lap Band is made of silicone and is placed around the upper portion of the stomach partitioning the stomach into two separate but connected reservoirs.  The stomach above the band is referred to as the pouch.  The stomach below the band is often referred to as the reservoir.  Although the stomach has been compartmentalized it is not cut or divided.  In other words, there is no permanent anatomical change made to the patient's stomach.   This technique leaves the digestive tract in the normal anatomical sequence for digestion and absorption. 

The intended effect is to reduce the stomachs capacity for a meal.   The shape of the stomach can be visualized as an hour glass. Once ingested, food slowly moves from the upper pouch into the lower reservoir through a narrowed passage between the two compartments.   The speed at which food flows through this channel is controlled by adjusting the diameter of the band.  The band is connected to a port that is secured to the abdominal wall deep underneath the skin.  In the doctor's office the port can be felt on examination and accessed with a special needle to make adjustments.  When sterile salt water is placed into the port it travels through the tubing and into the inner tube of the adjustable gastric band.  The inner tube inflates putting pressure around the upper portion of the stomach decreasing the size of the passage.  When optimally adjusted patients feel satisfied after small amounts of food, are less hungry in between meals and spend far less time thinking about food.   Post operative follow up and frequent adjustments are necessary throughout the first 6 months to one year after the operation to ensure success.  

One advantage of gastric banding is that the stomach is not cut, stapled, or entered.  Thus, the risk of infection is less and there is no possibility of staple-line disruption.  However, there is always a risk of injuring the esophagus or stomach when placing the band.  Other important advantages are that the operation is easy to revise and is the only completely reversible technique if such a need arises. In such a case, the band is removed and the stomach recovers its normal anatomy.