Gastric banding is a form of weight-loss (bariatric) surgery. It's used to treat people who have severe obesity and who haven't been able to lose weight through diet and exercise alone. It's most often done in adults. But in some cases it may be a treatment choice for a teen.

A gastric band is a soft, rubbery circle made of silicone. The band is attached to a thin, flexible tube (catheter). The tube is connected to a small, round port. During surgery, the band is put around the stomach, near the top. The port is put under the skin below the rib cage. Saline solution is injected with a needle and syringe through the skin into the port and goes through the tube to fill the band. The fluid makes the band expand and squeeze tighter. A doctor can control the size of the band by adding or removing saline through the port after the surgery.

When saline is added, the band tightens around the top of the stomach. This creates a small pouch where food goes during a meal. The food then slowly moves down into the rest of the stomach and is digested over time. The pouch is smaller than a whole stomach. So it makes a person full more quickly. It limits the amount of food they can eat.

After surgery, the band will need to be adjusted. This means regular follow-up visits to a doctor and the injection or removal of saline using the port that was put under the skin. At some point years after surgery, some bands will need to be replaced. This is done with another surgery.

Gastric bands aren't yet approved by the FDA for use on people younger than age 18. The surgery can still be done. But gastric bands have declined in use in both adults and youth because of negative long-term effects as well as high complication rates.

Some studies suggest that weight-loss surgery may improve the health of teens who have obesity. A teen may be able to bypass health problems linked to obesity. These include type 2 diabetes, sleep apnea, high blood pressure, and heart disease. The surgery may also help with social problems, such as being bullied.

Due to concerns about long-term effects and complications, a doctor will recommend the surgery only in special cases. A doctor may advise surgery for a teen who has a body mass index (BMI) of 40 or higher. Or surgery may be advised for a teen with a BMI of 35 to 40 or higher and other health problems, such as type 2 diabetes or sleep apnea. Surgery is considered if a teen has tried other ways to lose weight and has had no success.

Deciding whether your teen should have gastric banding surgery is complicated. Roux-en-Y gastric bypass or vertical sleeve gastrectomy may be more appropriate for adolescents. These two surgeries are recommended in the latest pediatric obesity guidelines for adolescents 13 years and older who have severe obesity. Work with your child's doctors, talk with your teen, and spend time learning about the surgery and life after this surgery. Together you can all figure out if surgery is the right choice for your teen.

Like all kinds of surgery, weight-loss surgery has risks. The risks of gastric banding include:

• Infection, including wound infection, pneumonia, abdominal infection, and urinary tract infection.
• Pain.
• Too much bleeding. Your teen may need a blood transfusion or more surgery. Too much bleeding can be fatal.
• Blood clots in the legs that can travel to the lungs.
• Poor wound healing.
• Risks of anesthesia, including death.

After surgery, the risks include:

• Nausea.
• Vomiting.
• Trouble swallowing.
• GERD (gastroesophageal reflux disease) or heartburn.
• Belly (abdominal) pain.
• Saline leaking from the gastric band.
• Stretching of the stomach or esophagus, leading to weight regain.
• The band eroding into the stomach tissue.
• The band slipping out of place.
• The need for more surgery to fix problems.

Before having this surgery, your child should:

• Have reached physical growth at near-final adult height.
• Be mentally and emotionally mature.
• Understand and be ready to commit to lifestyle changes.
• Have the support of their family.

A teen should not have the surgery if they:

• Lack interest in following the diet changes needed after surgery.
• Have an untreated eating disorder or mental illness.
• Are pregnant or breastfeeding.

If a teen has Prader-Willi syndrome, a comprehensive discussion with their doctor about the risks and benefits of bariatric surgery would be needed if surgery is being considered.

A gastric banding procedure is a major life change. Your teen will likely be asked to take classes to get ready for life after the surgery. They will learn new ways of eating and drinking, and they will need to commit to those changes to make the surgery a success.

After surgery, the small pouch at the top of the stomach fills up quickly. Your child will only be able to eat small amounts of food. Eating too much can lead to vomiting and other problems. Your teen will also need to take daily vitamin and mineral supplements. These are things that some children may not want to do or may not remember to do.

Talk with your teen about all the changes that the surgery will mean. You can also ask your child's doctor about local weight-loss surgery support groups. These can help your teen meet others who have had the surgery. And before they make a decision, they can ask questions about what the surgery is like. You may also want to contact a dietitian who can work with your child before and after surgery.

To get ready for the procedure, your teen will need to:

• Have a physical exam.
• Have blood tests, ultrasound, and other tests to make sure they are healthy enough for surgery.
• Talk with a mental health counselor to make sure they are ready for surgery.
• Go to nutrition classes or meet with a dietitian.
• Meet any other requirements as noted by doctors.

Your child will also need to:

• Not take certain medicines during the week before surgery, such as ibuprofen.
• Follow any directions for not eating or drinking before surgery.

A gastric banding surgery takes about 30 to 60 minutes. It follows this general process:

1. An I.V. (intravenous) line is put into your child's arm or hand. Medicine and fluids are sent through the I.V. Your child will be given medicine (general anesthesia) to cause them to sleep through the surgery.
2. The surgeon will make one to five small cuts in the belly. Through these small cuts, the surgeon uses small tools to do the surgery. These include a small camera that lets the surgeon see the surgery.
3. The surgeon will put the band around the top part of the stomach. The port is placed under the skin, below the rib cage.
4. The small cuts are closed with stitches (sutures) or surgical glue.
5. Bandages are placed on the cuts.

After the surgery, your teen is taken to a recovery room. They are watched by a doctor, and then sent to a hospital room.

Your child will likely stay in the hospital overnight. They will feel some pain and discomfort after surgery. This is normal. It's treated with pain medicine. The care team may also have your teen up and walking a few hours after surgery. This will help your child recover faster.

On the day after surgery, your teen will likely have an X-ray. This image is used to make sure that the gastric band is working normally. Your teen may be asked to swallow a liquid that can be seen on the X-ray.

When it's time for your child to go home, you'll be given instructions for how to care for your child's incisions and when to contact the care team.

After recovering from the surgery, your teen will need to:

• Chew food completely.
• Learn how much food they can eat.
• Make healthy food choices.
• Not eat certain foods.
• Get regular physical activity.
• See a dietitian and other care providers as often as needed.
• Have adjustments made to the band as needed.
• Have the band replaced when needed.

Before you agree to the test or procedure for your child, make sure you know:

• The name of the test or procedure.
• The reason your child is having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• When and where your child is to have the test or procedure.
• Who will do the procedure and what that person's qualifications are.
• What would happen if your child did not have the test or procedure.
• Any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to contact after the test or procedure if you have questions or if your child has problems.
• How much you will have to pay for the test or procedure.