- Background: The primary aim was to determine the rate and nature of late postoperative complications in relation to the type of band used and the route through which it encircled the stomach in a retrospective review of postoperative complications that necessitated reoperation in 500 consecutive cases of laparoscopic adjustable gastric banding (LAGB) conducted over the past 48 months. Methods: The four study groups were: (A) Lap-Band® perigastric route, 186 cases; (B) Lap-Band® pars flaccida route 73 cases; (C) SAGB perigastric 70 cases, and (D) SAGB pars flaccida, 171 cases. There were 414 women and 86 men. The mean age was 39.2 ± 11.0 years (17–68). The mean weight was 126 kg, and mean BMI was 43.4 kg/m2 prior to operation. Results: There were 32 cases of slippage (17%) in group A and five cases (7%) in Group B (P < 0.05). In group C there were 15 cases (21%) of slippage and in group D six cases (3%) (P < 0.05). There were no significant differences between Groups A and C or Groups B and D. Except for one case of band erosion in Group C, erosion, tube disconnection and aneurysmatic balloon dilatation occurred only in groups A and B. Band erosion occurred in 2% each in groups A and B, tube disconnection in 3% and 4%, respectively, and balloon dilatation in 2% in each of groups A and B. Conclusions: Slippage was primarily route dependent. Erosion, tube disconnection and aneurysmatic dilatation of the balloon were encountered almost exclusively in the high-pressure system. We conclude that the pars flaccida route with the low-pressure system is more effective in reducing the rate of complications necessitating reoperation.