Avoiding Complications after Laparoscopic Esophago-Gastric Banding: Experience with 400 Consecutive Patients

Abstract

The technique herein presented is effective and useful to prevent postoperative gastric slippage. It does not induce pseudo-achalasia, if strictly controlled. In fact, it is avoided by the patient due to the immediate appearance of dysphagia, in the case of wrong food ingestion. Long-term clinico-radiological follow-up confirms that the technique is safe and effective in motivated patients with good compliance and willing to undergo periodic studies.

The Gastric Banding

“…Monitoring and prevention of renal failure complications, such as hyperkalemia, increased uric acid level, or acidosis, is necessary. If it is impossible to control the above abnormalities with pharmacological treatment, dialysis is required [18][19][20].…”

“…The anamnesis findings concerning weight gain without any signs of band loosening are characteristic [14,[22][23][24][25][26][27][28]. ▬ Slippage (anterior and posterior), i.e., displacement of the anterior or posterior gastric wall above the band with consequent increase of the "upper" stomach volume, allowing ingestion of larger amounts of food, ⊡ te Riele et al [17] Naef et al [14] Lee et al [12] Boschi et al [21] Boschi et al [18] Lagandré et al [19] Vomiting due to stoma edema 0. often with obstruction at the band site associated with too large "volume" of the gastric wall inside the band lumen. Conservative management (loosening of the band, liquid diet) can be attempted, but most cases require surgical correction (restoration of the previous band placement with fixation, sometimes replacement of the band with another one, another bariatric procedure) [25,[29][30][31][32][33][34].…”

Management of Complications Related to Laparoscopic Adjustable Silicone Gastric Band

“…Demographic studies show a recent increase in the prevalence of morbid obesity worldwide. This increase has been linked to changes in nutritional behavior [1,4]. One of the most recent and careful global estimates finds that roughly 500 million adults are obese [25].…”

“…One of the most serious complications associated with gastric banding is erosion of the band into the gastric lumen [2], and its incidence ranges between 0.6% and 11% [2][3][4][11][12][13][14][15][16][17]. After an initial tear of the serosal layer of the stomach, the band erodes the complete thickness of the gastric wall and enters the lumen.…”

“…Lattuada et al reported successful endoscopic removal of five devices, two laparoscopically, and other two through laparotomy [19]. Bueter et al reported laparoscopic band removal with closure of the gastric wall after band erosion [16] and Boschi et al reported laparoscopic band removal with gastric closure using an Endo-GIA stapler [4]. In their study, Tolonen et al performed band removal with simultaneous gastric bypass operation via laparotomy in three of four patients with gastric wall erosion [11].…”