LAGB ( Laparoscopic Adjustable Gastric Banding ) is a surgical procedure, done to surgically reduce obesity, that involves the placement of a band ( adjustable ) around the upper part of the stomach using a laparoscope. The band is made of silicone. It is tightened by adding saline to the band. 

Lap band reduces obesity by restricting the size of the stomach and holding the amount of food. This band is made of silicone, it is tightened by adding the saline to fill the band, the band is connected to a port which is placed in the skin of the abdomen. This port helps to deliver the saline into the band. It also slows the rate at which food passes into the intestine. 

Lap band surgery is suitable for the following candidates- people with BMI over 40 kg/mg2, for patients who have BMI in the range of 35-40 kg/mg2 and have associated medical conditions like ( high blood pressure, diabetes).

LAGB or lap  band surgery is contraindicated in- patients who can not understand the procedure, are weak emotionally, or have drug/ alcohol dependence, history of stomach ulcers or stomach problems ( need to be medically checked properly ), patients with diseases like- heart or lung conditions. 

The duration of Lap band surgery recovery is shorter than Gastric Bypass surgery. People can resume the work in 1 week with proper precautions. Normal physical activities can resume in 6 weeks. 

The patient will have pain for a few days after the Lap band surgery. This is part of normal recovery and pain controlling medications are given. Patients can return to work in 1 week and full physical activities in 6 weeks. Weight Loss will be gradual, 2-3 pounds a week. Certain food modifications are to be followed strictly. In the first year average weight loss is 40% , whereas in the second year it is 10-20%. 

The lap band lasts for 7-10 years. 

All bariatric surgeries ( weight loss surgeries) are major surgeries, including the lap band surgery.

Lap band surgery is considered to be a safe surgery, with a very low (0.1%) mortality rate. 

The side effects of lap band surgery are- nausea, vomiting, ulcer at the site of band placement, indigestion, acid reflux, weight regain, dehydration. 

The cost of Lap band surgery in India varies across different cities and hospitals-

Lap band surgery is normally performed in the following cases:

• When an obese person is cannot lose weight through diet and exercise. The surgery is normally done in the following cases:
• A person having a body mass index (BMI) (measured by dividing weight in kilograms by height in meter square) of more than 40.
• A person having a BMI of 35 to 39.9, and having at least one serious health disorder like high blood pressure, diabetes, or obstructive sleep apnea (a breathing disorder in which the breathing suddenly stops and starts many times during sleeping).
• A person having a BMI of 30 to 34.9, and diabetes or another metabolic syndrome that cannot be controlled by medicines.
• An Asian patient having fat accumulation in the stomach area, known as central obesity, and having diabetes that is not controlled, even though the BMI may be as low as 27.5.
• For treating or reversing obesity-related conditions like diabetes, hypertension (high blood pressure), diabetes, and obstructive sleep apnea.

A lap band surgery should not be performed in the following conditions:

• Drug addiction
• Alcoholism
• Severe lung disorder
• A person undergoing cancer treatment
• Portal hypertension (increased blood pressure in the portal vein, which goes to the liver)
• Heart failure (when the heart fails to pump sufficient blood to the rest of the body)
• Coronary artery disease (buildup of plaque in the major blood vessels of the heart)
• Impaired intelligence and mental ability
• Intolerance to anesthetic agents
• Unwillingness or inability to attend regular follow-ups following a surgery
• Unwillingness to follow diet recommendations and exercise routine after the surgery

Lap band surgery is performed by a bariatric surgeon or general surgeon.

The following tests are performed before a lap band surgery:

1. Physical examination: The doctor examines the patient physically and notes down the medical history and family history of the patient.
2. Blood tests: The different parameters of blood and nutrient levels are checked using a blood test. Underlying medical conditions, like thyroid diseases and diabetes, can also be diagnosed using blood tests.
3. Chest x-ray: A chest x-ray helps in checking the condition of the internal organs in the chest region, namely the lungs and heart.
4. Electrocardiogram (ECG): The electrical activity of the heart is recorded using this test. It also helps in detecting any heart problems.

The following preparation may be needed for a lap band surgery:

• Inform the doctor about any medications, supplements, or herbs that you may be taking.
• Inform the doctor if you have any medical illnesses.
• If you have any allergies, inform the doctor about the same.
• If you are pregnant or think that you can be pregnant, inform the doctor.
• Your doctor will tell you to stop taking blood-thinners like warfarin and aspirin a couple of days before the procedure.
• Avoid eating or drinking anything after midnight the day before the surgery.

• Lap band surgery is generally performed under general anesthesia (the patient is put to sleep during the procedure).
• The stomach or abdominal region is first cleansed using an antiseptic solution.
• The doctor then proceeds to make incisions or cuts in any one of the following ways: 
• Laparoscopic incision: This procedure involves making many small incisions (about one-fourth to half an inch in size) in the abdominal area. A long tube having a camera on one end, known as a laparoscope, is inserted inside the abdomen, along with other small surgical instruments through the small incisions that are made.
• Incision for open surgery: This procedure involves making a single, large, 10-to-12-inch incision in the abdominal area.
• An adjustable gastric band (a soft silicone ring) is then placed through the incisions around the upper stomach region.
• The gastric band is then tightened and a small stomach pouch is created.
• A small device, known as a port, is placed under the abdominal skin and the band is attached to the port by a thin tube.
• Saline or saltwater can be injected inside and removed through the skin of the abdomen. The saline can flow into or out of the silicone band.
• The saline fills up the band and makes it tighter. 
• The band can be tightened or loosened in this way to reduce the side effects and enable weight loss.
• The surgical instruments are then removed and the incision site is closed using sutures (stitches) and sterile tape.
• This procedure takes about half an hour to one hour to complete.

The following post-procedure steps are followed after a lap band surgery:

• You will have some pain after the surgery. Your doctor will prescribe pain-relieving medications for the same.
• You will most likely be discharged from the hospital one or two days after the surgery.
• You will be told to move around as soon as possible to aid in quick healing and prevent the formation of blood clots.
• Deep breathing exercises will be taught using a plastic device called an incentive spirometer.
• You will be on a clear liquid diet for fifteen days after the surgery and gradually return to your normal diet.
• It is recommended to walk regularly or do light exercises after the surgery.
• Strenuous activities and heavy lifting should be avoided for about three to six weeks after the procedure.
• Drink lots of water every day.
• Avoid driving for at least a week after the procedure.
• Take nutritional supplements as recommended by your doctor.
• Follow-up appointments with the doctor will be needed for band adjustments, which are necessary for adequate loss of weight.

The advantages of a lap band surgery are:

• Long-term loss of weight in an obese person (approximately 40 to 60 percent of excess weight can be lost)
• Quick recovery
• Lesser chances of wound infection and hernias (bulging of a tissue or organ through an abnormal opening) after the procedure
• Reduced risk of obesity-related conditions like diabetes, high blood pressure, urinary incontinence (involuntary urine leakage)
• Improved quality of life 
• Absorption of nutrients is not lost

The possible side effects of lap band surgery are:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to the anesthesia used
• Breathing difficulties
• Stroke (a condition caused due to interrupted blood supply to the brain)
• Heart attack
• Injury to the abdominal organs like stomach and intestines
• Heartburn (a burning sensation in the chest)
• Stomach ulcers
• Hernia 
• Gastritis (inflammation of the stomach lining)
• Bowel blockage due to scarring
• Poor nutrition
• Reduced food intake
• Regaining the lost weight 
• Slipping of the band
• Dilation of the pouch