Laparoscopic adjustable gastric banding via pars flaccida versus perigastric positioning: technique, complications, and results in 2,549 patients

Abstract

Aim Retrospective multicenter analysis of the results of two different approaches for band positioning: perigastric and pars flaccida. Methods Data were collected from the database of the Italian Group for LapBand Ò (GILB). Patients operated from January 2001 to December 2004 were selected according to criteria of case-control studies to compare two different band positioning techniques: perigastric (PG group) and pars flaccida (PF group). Demographics, laparotomic conversion, postoperative complications, and weight loss parameters were considered. Data are expressed as mean ± standard deviation. Results 2,549 patients underwent the LapBand System Ò procedure [age: 40 ± 11.7 years; sex: 2,130 female, 419 male; body mass index (BMI): 46.4 ± 6.9 kg/m 2 ; excess weight (EW): 60.1 ± 23.6 kg; %EW: 90.1 ± 32.4]. During this period 1,343/2,549 (52.7%) were operated via the pars flaccida (PF group) and 1,206/2,549 (47.3%) via the perigastric approach (PG group). Demographics for both groups were similar. Thirty-day mortality was absent in both groups. Operative time was significantly longer in the PG group (80 ± 20 min versus 60 ± 40 min; p \ 0.05). Hospital stay was similar in the two groups (2 ± 2 days). Laparotomic conversion was significantly higher in the PG group (6 versus 2 patients; p \ 0.001). Overall postoperative complication rate was 172/2,549 (6.7%) and was linked to gastric pouch dilation/slippage (67/172), intragastric migration/erosion (17/172), and tube/port failure (88/172). Gastric pouch dilation and intragastric migration were significantly more frequent in the PG group: 47 versus 20 (p \ 0.001) and 12 versus 5 (p \ 0.001), respectively. Patients eligible for minimum 3-year follow-up were 1,118/1,206 (PG group) and 1,079/1,343 (PF group). Mean BMI was 33.8 ± 12.1 kg/m 2 (PG group) and 32.4 ± 11.7 kg/m 2 (PF group) (p = ns), and mean percentage excess weight loss (%EWL) was 47.2 ± 25.4 and 48.9 ± 13.2 in PG and PF groups, respectively (p = ns). Conclusions Significant improvement in LapBand System Ò results with regard to laparotomic conversion and postoperative complication rate, with similar weight loss results, was observed in the pars flaccida group.

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

“…Hypovolemic shock with massive upper gastrointestinal hemorrhage due to erosion into the celiac axis or in the left gastric artery has been reported, as well as small bowel obstruction due to intragastric band erosion [24][25][26]. In most cases, clinical symptoms are absent or mild and transient, and many authors agree that a pathognomonic manifestation of intragastric erosion is absent [1][2][3][4][5][6]14].…”

“…Bands were implanted by a pars flaccida or a perigastric route with the patient in an anti-Trendelenburg position; antibiotics and antithrombotic prophylaxis were given [14]. Until 1997 the vast majority of centers whose patients participated in this study used the perigastric approach, while after 2005 almost all moved to the pars flaccida route.…”

Complications from Laparoscopic Adjustable Gastric Banding: 364 Cases Experience

“…Adjustable gastric banding probably represents the most frequent performed bariatric surgery. LAGB is considered to be an effective method of weight loss [8][9][10], however, all surgical procedures have specifi c complications related to the LAGB, requiring a process for assessment and medical management, a change in lifestyle, diet, and LAGB revision surgery in 20-60 % of cases for failures and/or complications [11,12], which have been listed as gastric band malposition, gastric band erosion, chronic gastric band erosion, gastric band slippage, pouch dilatation, gastric stomal stenosis, catheter malfunction, port-catheter disconnection, catheter-band disconnection, proximal esophageal dilatation without stomal stenosis, esophageal dysmotility, refl ux and esophageal gastrifi cation; being the pouch enlargement, band slip, band erosion, port-site infections and port breakage the most commonly associated with LAGB [13]. There are some specifi c problems related to the device with percentage reported in literature, like: band erosion (2.1% -9.5%); band intolerance; band leak (1.1% -4.9%) and band slippage (2% -18%).…”

“…The most common presentation is abdominal pain (83%) followed by weight regain and port-site sepsis or port infection associated in 50% of cases, the abdominal pain is constant and is not related to eating, it usually appears in epigastrium and may radiate to the upper back, left subcostal area. When infl ammation is originated from a gastric perforation, the patient complains of intermittent and severe pain in the lower abdomen, requiring gastric band removal [11,20]. 201 patients with gastric band erosion were treated by laparoscopy, the band was removed and the fi stulous orifi ce was closed with a few stitches on the damaged gastric wall and reinforced with an omentum patch.…”

Safety and effectiveness of laparoscopic management in 210 patients with erosion of adjustable Gastric banding

“…The possible causes of BE are gastric tight sutures, chronic ischemic tissue damage, contamination or infection of the band, an adjustment port infection immediately after surgery, injuries of the gastric wall dissection, and excessive band illing. The BE risk appears to be minimized with plication of the stomach with pars laccida [16] to cover the band without tension and to ensure that the buckle is free; also it is recommended to treat all infections of the port early on. Of all possible recommendations [17][18][19] to avoid this very serious complication, we would advise counseling patients to opt for different LAGB bariatric procedures.…”