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

Abstract

Objective: To evaluate laparoscopic adjustable gastric banding and the ‘pars flaccida’ techniques for treating morbidly obese patients. Subjects and Methods: Between May 1999 and July 2002, 64 patients underwent laparoscopic adjustable gastric banding. The ‘perigastric’ technique was performed in the first 31 patients. From September 2000 the band was positioned according to the ‘pars flaccida’ technique in the remaining 33 patients. The patients were divided into three groups: group 1 – ‘perigastric’ technique using Lap-Band size 9.75 and 10 cm (31 patients); group 2 – ‘pars flaccida’ technique using Lap-Band size 10 cm (12 patients), and group 3 – ‘pars flaccida’ technique using the Swedish band (21 patients). There were 58 females and 6 males with a mean age of 36.6 years (range 17–56). The preoperative mean body mass index was 46.2 kg/m². Results: Band slippage occurred in 10/31 patients (32.2%) of group 1, 3/12 patients (25%) of group 2 and none in group 3 patients (p < 0.01). Conclusion: The ‘pars flaccida’ technique significantly reduces the incidence of postoperative slippage after gastric banding. This complication is further reduced in the Swedish band group. Furthermore, we do not recommend using the 10-cm Lap-Band in the ‘pars flaccida’ technique.

Reducing Band Slippage in Laparoscopic Adjustable Gastric Banding: The Mesh Plication Pars Flaccida Technique

“…This effect has been reported similarly by other authors [2,11,13,18,19]. Furthermore, we have reported the use of a new technique, which further modifies the PFT, by the addition of mesh pledgets and plication.…”

“…This has since been referred to as the pars flaccida technique (PFT). With the use of the PFT, the rate of band slippage has fallen to less than 3% [2,4,7,9,[11][12][13]. With a view to further reducing the rate of posterior slippages, O'Brien et al (1999) emphasized that the posterior level of the band should be above the upper limit of the lesser sac (so that it is extra-peritoneal) and placed a single mesh pledget on the posterior wall of the stomach (by opening up the lesser sac below the greater curve) to further "stick down" the stomach below the band [13].…”

Clinical application of laparoscopic bariatric surgery: an evidence-based review

“…This has efficacy equivalent to the initially described perigastric approach but a significantly decreased rate of band slippage (i.e., gastric prolapse) [186][187][188]. The pars flaccida approach results in the incorporation of more extraneous tissue, particularly the lesser curvature fat pad, into the band.…”

SAGES guideline for clinical application of laparoscopic bariatric surgery

“…This has equivalent efficacy to the initially described perigastric approach, but has a significantly decreased rate of band slippage (i.e., gastric prolapse) [186][187][188]. The pars flaccida approach results in more extraneous tissue, particularly the lesser curvature fat pad, being incorporated into the band.…”