The weight loss following LAGB is gradual, 0.5–1 kg per week, and optimal outcomes require lifelong follow-up [13]. Follow-up is more intensive in the first year, with most patients requiring 6–8 visits [14, 15]. After the first year, most patients only require six monthly or annual visits. This model of care fits with the management of obesity as a chronic disease, and has been shown to be cost-effective [16–18].

There have been two prospective multicenter Food and Drug Administration-monitored clinical trials in the United States. The Lap-Band trial A [19] recruited patients from 1995 to 1998 in eight centers; 259 out of 292 patients had the band implanted laparoscopically by perigastric dissection. The average EWL was 26.5 % at 6 months, 34.5 % at 12 months, 37.8 % at 24 months, and 36.2 % at 36 months. The very high incidence of gastric prolapse and slippages was attributed to the learning curve, as most of the surgeons involved were inexperienced laparoscopic surgeons, as well as the use of the perigastric dissection rather than pars flaccida. There was also a lack of effective follow-up, with an average of only 1.2 adjustments in the first year. The majority of patients were adjusted by radiologist based on a contrast swallow evaluation rather than tailoring the adjustment to the patient’s sensation of satiety. There was no good band-specific patient education program.

The Swedish Band clinical study [20] recruited 276 patients in 12 centers in 2003. All patients were implanted laparoscopically by pars flaccida technique. This trial included centers with both large and no experience with gastric banding management. The mean % EWL at 3 years was 41.1 %.

There have been two prospective randomized clinical studies comparing gastric banding with the gastric bypass. Angrisani [21] randomized 51 patients and allocated them to undergo either banding (n = 27) or gastric bypass (n = 24). At 5 years after the procedure, the band patients had an average % EWL of 47.5 % vs. 66.6 % for the gastric bypass group. In a similar study, Nguyen [22] randomized and followed 86 patients with gastric banding and 111 with gastric bypass. The % EWL at 4 years was 45 % vs. 68 %, respectively.

There have been four randomized controlled trials assessing the effectiveness of LAGB with conservative weight loss programs, with all showing substantially better weight loss and comorbidity resolution in the surgical arm [23–26]. In the initial trial, patients with a body mass index between 30 and 40 kg/m² the gastric banding group showed 87 % EWL compared with the conservative arm 22 % EWL at 2 years of follow-up [23].

There have been several meta-analyses and systematic reviews of the literature that included a significant number of gastric band patients. Buchwald et al. [27] published a large bariatric surgery meta-analysis and systematic review that included 136 studies with 3,873 LAGB patients with the majority of the studies having 2 years or less follow-up reported. The mean EWL was 47.5 %. O’Brien et al. [13] extracted reports out of the English literature with more than 100 patients and at least 3-year follow-up. 4,456 band patients were analyzed, and EWL at 1, 3, 5, and 8 years was 42.6 %, 57.5 %, 54 %, and 59.3 %, respectively. Finally, Cunneen et al. [28] published a systematic review comparing data available on the two bands: a total of 129 studies (33 with Swedish band data and 104 with Lap-Band data). The 3-year mean Swedish and Lap-Band EWL was 56.4 % and 50.2 %, respectively, without statistically significant difference.

There have been seven case series reporting long-term (≥10 year) outcomes [29–34]. The weighted mean at maximum follow-up was 51.7 % EWL (Table 2) [12].