Controversies in bariatric surgery: evidence-based discussions on laparoscopic adjustable gastric banding.

Laparoscopic adjustable gastric banding (LAGB) is a surgical option that involves placing a silicone band circumferentially around the uppermost aspect of the stomach. The band creates a small proximal pouch that empties slowly resulting in early satiety and a decreased appetite. The band is attached to an access port that is secured to the rectus muscle and can be accessed percutaneously in the office with a needle. Injection of saline into the port results in tightening of the band. This is performed on an individual basis according to weight loss and appetite. Band adjustments are required approximately 5-6 times in the first year and 2-3 times in the second year. Weight loss is gradual, averaging 1-2 lb/week during the first 2 years after surgery.