A Technique for Prevention of Port Complications after Laparoscopic Adjustable Silicone Gastric Banding

Abstract

With the larger surface area by which the port is attached to the fascia, a stable position of the port is obtained and dislocation avoided. Multiple failed attempts at port access, with resulting risk of infection, are avoided. Due to port stability, risk of incidental tube perforation is reduced. Moreover, a considerable gain of time is obtained compared with the classical suturing of the port.

A 6-year experience with the Swedish adjustable gastric band

“…A month after surgery, inflation of SAGB was commenced by injecting 3 or 4 ml of a radiology contrast medium (Iopamiro isotonic 200 mg IO; Bracco, Milan, Italy) under aseptic conditions in an out- [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Of the 190 patients who underwent SAGB, 184 (97%) could be followed up (mean, 39.4 ± 18.4 months; duration of follow-up, 6-72 months).…”

“…We prefer to fix the port with periostal stitches in the lower third of the sternum because this helps reduce possible twisting or moving of the port. Fabry et al [10] described an alternative technique by suturing the port onto a polypropylene mesh, which is secured to the rectus fascia in the left hypochondrium using a Tacker stapling device. Despite proper placement of the port, careful disinfection of the punction area as well as the proper punction of the port are of utmost important to prevent port complications.…”

Laparoscopic adjustable gastric banding: is there a learning curve?

“…Fabry et al [5] encountered quite a few of these and consequently changed their procedure, affixing the port to a polypropylene mesh and securing the mesh to the rectus fascia. We likewise ensure adequate anchoring of the access port to the rectus fascia in order to lower the risk of malposition.…”

Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study

“…Selection of the optimum port implant site (e.g., pre-sternal, left upper abdomen) plays a role in stabilization; the evidence [10,15,24] is not conclusive as to the best anatomical position for port fixation, and the answer to this question may be a function largely of band-specific engineering and band shape relative to implant-site selected. In seeking to stabilize the port, Fabry et al [30] have used a technique of first attaching it to a polypropylene mesh, then stapling the mesh to the anterior rectus fascia, resulting in a port implant time of several minutes and a low rate of port morbidity over a short (undisclosed) follow-up period. With the same objective, Mizrahi and Avinoah [31] described their technique, used over 6 years in 2800 procedures, of fitting the port into a pre-sternal pouch without fixation of any kind, an approach that reduced their implant time and lowered their incidence of port complications requiring reoperation.…”