Morbid obesity is a widely recognized worldwide epidemic. It is known as the second most common cause of preventable death in the United States, after smoking. Bariatric surgery, the surgical management of obesity, has demonstrated a substantial reduction in overall mortality in morbidly obese individuals according to multiple long-term studies. 
Bariatric surgery was first conducted in the 1960s as the jejunoileal bypass procedure. This procedure showed good weight loss results involved numerous complications, especially malabsorption. Over time, surgeons worked to develop techniques with fewer complications. The Roux-en-Y gastric bypass was introduced in 1977 and became the procedure of choice by the 1980s. The nonadjustable gastric band procedure was introduced in the late 1970s with poor results, but the first adjustable gastric band was placed in 1985. The results of the adjustable band were released in 1986. They demonstrated improved weight loss with decreased complications when compared to nonadjustable gastric banding. The first laparoscopically-placed adjustable gastric band (LAGB) was placed in 1993. Due to its technical ease, it became one of the more popular weight loss surgeries in Europe and Australia in the late 1990s. Laparoscopic adjustable gastric banding was approved in the United States in 2001. Its popularity grew annually until 2008, then began to decline rapidly. The decrease in its use is attributable to the introduction of the sleeve gastrectomy. The laparoscopic sleeve gastrectomy was introduced in 1999. Its long-term results as a stand-alone procedure were becoming apparent in the late 2000s. In 2008 the indications for laparoscopic sleeve gastrectomy were published. By 2016 it had become the most commonly performed bariatric surgery in the United States. By 2015, laparoscopically adjusted gastric banding constituted only 5.7% of all bariatric procedures performed in the United States. It is rarely done. 
The two primary mechanisms by which bariatric surgery allows a patient to lose weight are restriction and malabsorption. Restriction refers to achieving weight loss by limiting the intake of calories. Malabsorption refers to altering the intestinal tract to bypass a certain length of small intestine. This bypass results in a decrease in absorption of ingested nutrients. Some procedures change bodily hormonal concentrations which also lead to weight loss and resolution of co-morbidities. The laparoscopic adjusted gastric bypass is strictly a restrictive procedure, which may explain why its long-term results are inferior to other bariatric surgeries. 
Although the performance of this procedure is rare in the modern era, many patients may continue to have adjustable gastric bands. Therefore, it is necessary to educate clinicians on the laparoscopic adjusted gastric banding technique to diagnose and treat any potential complications in a safe and timely manner.
The stomach is a muscular tube consisting of four layers. It begins at the diaphragmatic hiatus, the lower esophageal sphincter, and ends as it continues as the first portion of the duodenum. The divisions of the stomach include the cardia, which is just distal to the gastroesophageal junction, the fundus which abuts the left diaphragm, the body, the antrum, and the pylorus which is the most distal portion entering the duodenum. The lesser curvature lies beneath the medial segments of the liver. It contains the incisura angularis, which is the junction of the vertical and horizontal parts of the lesser curvature that marks the transition of the body to the antrum. The greater curvature is the long left lateral edge of the stomach from the fundus to the pylorus which connects to the greater omentum. The left border of the intraabdominal esophagus and the fundus meet at an acute angle called the angle of His.
The celiac trunk has three branches including the left gastric, common hepatic, and splenic arteries. The left gastric artery runs along the superior lesser curvature and anastomoses with the right gastric artery. The common hepatic artery gives off the gastroduodenal artery which runs behind the first portion of the duodenum. The right gastric artery is a branch of the proper hepatic artery. It joins the left gastric artery along the lesser curvature. The right gastroepiploic artery then branches from the gastroduodenal artery and runs in the gastrocolic ligament along the greater curvature. It then joins the left gastroepiploic artery which is a distal branch of the splenic artery coursing along the greater curvature from lateral to medial. The splenic artery also gives off three to five short gastric arteries running in the gastrosplenic ligament to the gastric fundus.
The indications for bariatric surgery were first described in 1991. The classic criteria for a patient to be a candidate for any bariatric surgery include:
Updates to these criteria have included patients with a BMI of 30 to 35 with obesity-related comorbidities as an indication for laparoscopic adjusted gastric banding. 
This procedure is contraindicated for patients unable to tolerate general anesthesia. It is also contraindicated for those with uncontrollable coagulopathy or those at a prohibitive operative risk.
Relative contraindications include Prader-Willi syndrome, malignant hyperphagia, untreated severe psychiatric illness, pregnancy, cirrhotics with portal hypertension, autoimmune connective tissue disorders, chronic inflammatory conditions, and the need for chronic corticosteroid use. 
This operation requires basic laparoscopic equipment, including insufflation with carbon dioxide, drapes, monitors, laparoscopic instruments, and electrocautery. Contrary to conventional laparoscopic procedures, bariatric patients will require longer trocars and laparoscopic instruments to accommodate for the thicker abdominal wall.
Laparoscopic adjusted gastric band procedures specifically require three 5 mm trocars, one 15 mm trocar, a liver retractor, an angled laparoscope, and a gastric band. There are two approved bands in the United States.
The operative procedure requires an anesthesiologist, a primary surgeon, a scrub nurse, and a first assistant.
The patient will be given preoperative antibiotics 30 minutes before incision as well as venous thromboembolism prophylaxis. The hair on the abdomen is removed with clippers in the preoperative area. The patient is placed on the operating table and secured well. After the induction of anesthesia, an orogastric tube is positioned within the stomach. The patient is placed in the modified lithotomy position with their arms extended. Routine skin preparation is completed from the nipples to the pubic symphysis. A time-out is performed.
There are many ways to perform a laparoscopic adjustable gastric band procedure. The following example employs the pars flaccida technique.
Laparoscopic adjusted gastric banding has the lowest mortality of all the bariatric procedures, ranging from 0.02% to 0.1%. It carries a 3% 30 day morbidity and a 12% rate of late complications, though this varies among the literature.
Early complications include:
Late complications include:
Long-term outcomes of the laparoscopic adjusted gastric band procedure are incredibly variable. This method was once one of the most popular weight loss procedures. It accounted for 42.3% of all bariatric surgeries worldwide in 2008. With the peak of its popularity gone, laparoscopic adjusted gastric banding accounts for a minority of weight loss procedures. This change is attributed to the publication of long-term results of gastric banding as well as sleeve gastrectomy procedures. Studies demonstrated a reasonable long-term excess weight loss ranging from 33% to 60%, with still lower percentages when compared to gastric bypass. However, they also showed extremely high long-term reoperation rates requiring gastric band removal, ranging from 8% to 60%. ,,,,
Surgeons were discouraged from gastric banding due to its poor long-term outcomes and the need for close follow up for frequent adjustments. It is a low-risk procedure in the perioperative period. However, it is associated with patient frustration and lower rates of compliance, leading to poor excess weight loss. Despite this reputation, many publications demonstrate a low risk of reoperation and band removal, ranging from 1.2% to 3.7%, when evaluating long-term data for laparoscopic adjusted gastric banding.,,, These results may be attributed to surgeon experience and advances in techniques that limit complications, such as the pars flaccida technique. The sleeve gastrectomy in meta-analyses has demonstrated excellent long-term results, low complication rates, and technical ease of operation when compared to the Roux-en-Y gastric bypass surgery. Sleeve gastrectomy was not recognized as an independent weight loss procedure until long after gastric banding was established. It was previously the first of two operations for the duodenal switch procedure. However, its success is a clear contributing factor to the decline of the number of laparoscopic adjusted gastric band procedures being performed.
For bariatric surgery, the patient is required to be evaluated by a multidisciplinary team before being a surgical candidate. This team includes a nutritionist, a psychiatric specialist, the surgical team, nurse practitioner, and the primary care physician. It is recommended but not required to conduct a preoperative esophagogastroduodenoscopy before laparoscopic adjusted gastric band surgery.
A clinician must be familiar with bariatric procedures and their complications. Bariatric surgery has proven extremely efficacious in the treatment of obesity. The laparoscopic adjusted gastric band procedure is rarely done. However, many patients have previously undergone this surgery and may present with complications unique to this procedure. It is imperative that these pathologies be understood, recognized, properly evaluated, and treated promptly.
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