Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases

Abstract

The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure.

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

“…Posterior slippage has been described in several studies and it is definitely related to transbursal band positioning [1, 8, 9, 10]. From the radiologists point of view, ‘posterior slippage’ means a dislocation of the inferior and posterior part of the band in relation to the stomach where the band rotates counterclockwise.…”

“…In contrast, ‘anterior slippage’ may still occur following suprabursal band placement, but this will only happen in patients in whom the seromuscular stitches have burst. According to the findings in the literature and based on our own experience we can state that both types of band dislocation may occur with the LAP-BAND and with the Swedish Band as well where the incidence of each type of slippage only depends on the surgical technique used for band implantation [8, 9, 10, 11, 12, 13, 14, 15, 16]. …”

“…Therefore, patients will present with regurgitation, food intolerance or even dehydratation [11, 12, 13]. In pronounced cases of posterior slippage and excessive eccentric pouch dilatation even more serious complications such as perforation, bleeding, infarction and/or gastric volvulus are possible [1, 8, 9]. …”

“…Pouch dilatation is known to be a possible early or late complication following ALGB implantation [1, 8, 9]. ‘Concentric’ pouch dilatation is not dangerous and it mostly presents as a prestenotic dilatation in cases where the band had been overinflated or in the presence of a normal lumen width if patients do not change their nutritional habits and chronically overfill their pouches [1].…”

“…Intestinal bypass, gastric resection, and biliopancreatic diversion have been used with different clinical outcome [3, 4, 5]. In 1983 Kuzmak [6, 7]introduced the gastric banding procedure and 1992 the first adjustable laparoscopic gastric banding was implanted [8]. This system consists of an inflatable silicon band which is placed around the proximal stomach with the intention of producing a small neo-stomach (i.e.…”