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Background: Although laparoscopic adjustable gastric banding (LAGB) has been increasing in popularity, controversy is ongoing in regard to its efficacy, safety and durability. Particular concern exists now that this technique is being adapted in the community setting. We report a single surgeon's experience of LAGB in a community practice serving a medium-size Midwest town in the United States., Methods: From March 30, 2004 to December 2, 2009, 442 patients underwent LAGB (77% women; mean age 47 years, range 18-71; mean body mass index 47 kg/m(2), range 35-78). The maximal number of primary procedures performed in a 12-month period was 105. Follow-up information was available for 94% of patients., Results: The perioperative mortality rate was 0%. The average percentage of excess weight loss was 27% at 6 months (n = 384), 38% at 12 months (n = 301), 44% at 18 months (n = 260), 48% at 24 months (n = 190), 51% at 36 months (n = 135), 58% at 48 months (n = 66), and 60% at 60 months (n = 31). By 60 months, 10% had failed to lose ≥25% of their excess body weight. The explantation rate was 1.8%. Gastric prolapse occurred in 2.0% of patients and erosion in 0.4% of patients., Conclusion: LAGB can be done safely in a community setting with acceptable weight loss and low failure rates. LAGB is less technical than other procedures; however, the results depend heavily on meticulous long-term follow-up. We have proposed a strategy that has been effective in the community setting., (Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)