Anterior versus Posterior Slippage: Two Different Types of Eccentric Pouch Dilatation in Patients with Adjustable Laparoscopic Gastric Banding

Abstract

Purpose: To describe two different types of band dislocation that may occur in morbidly obese patients following adjustable laparoscopic gastric banding (ALGB) with the LAP-BAND. Materials and Methods: 170 morbidly obese patients were treated with an LAP-BAND at our institution. In the first 20 patients the band was positioned transbursally, which means that the lesser sac is penetrated during laparoscopic band implantation. In the following 150 patients the operation technique was changed to suprabursal band positioning where the lesser sac is not penetrated. Plain radiographs and single contrast studies of all patients who developed band instability in the follow-up were analyzed retrospectively and compared to the clinical and intraoperative findings and to the operation technique used. Results: Over a time period of 3.5 years ‘posterior slippage’ occurred in all 20 patients with transbursal band placement, but it never occurred after suprabursal band placement. Never- theless 4 patients with suprabursal band placement presented with an eccentric pouch dilatation, secondary to ‘anterior slippage’ after the seromuscular stitches had burst on the anterior and superior surface of the band. All these patients presented with food intolerance and all of them had to be reoperated. The radiographic findings were pathognomonic for each type of band dislocation. Conclusion: Band dislocation is a known major complication that may occur following ALGB and it may present in two different forms. While ‘posterior slippage’ can be avoided if the band is placed suprabursally, ‘anterior slippage’ may still occur. It is important to be familiar with both types of band dislocation since they require early detection and surgical band replacement or band refixation.

Slippage after Adjustable Gastric Banding according to the Pars Flaccida and the Perigastric Approach

“…Posterior slippage makes the band move to the vertical position due to unrecognized penetration of the lesser sac. This is a more difficult complication and the band needs to be placed more proximally or removed [8,14,15] .…”

A Rare Complication After Laparoscopic Gastric Banding: Connecting-Tube Penetration into the Hilus of the Kidney

“…The operation technique changed to a suprabursal band position (the pars flaccida technique), resulting in a significant reduction of the incidence of slippage. Still, percentages of 0.6-5% are reported [5,[10][11][12][13]. Migration of the band through the gastric wall has been described in approximately 1% (range 0.5-3.8%) [4-8, 14, 15].…”

Band slippage after laparoscopic adjustable gastric banding: etiology and treatment

“…Upper pouch dilatation with downward band slippage is the most prevalent complication of laparoscopic adjustable gastric banding using the LAP-BAND device [4,5,9,14,15,17]. It should be distinguished from simple upper pouch dilatation, which is usually concentric and is not accompanied by band slippage.…”

“…However, among the complications that require revisional surgery are band erosion [2] and band slippage [17]. Band dislocation, or slippage, with upper pouch dilatation manifests as a complete or partial stomach obstruction and requires operative treatment.…”