Abstract
Background
Although reports on band erosion management after laparoscopic adjustable gastric banding (LAGB) agree that in most cases the affected band will need to be removed, there is no consensus on the technique of removal. We report a minimalistic, laparoscopic technique which is safe and avoids management delay.
Methods
We retrospectively reviewed the operative log of our obesity surgery unit to find all operations performed on LAGB patients for erosion from Jan 2003 to Dec 2007. The cases that underwent this particular technique were identified. Case notes and electronic records were then reviewed for postoperative morbidity and outcomes. The operative technique and indications of this particular method is described which to our knowledge has not been reported before.
Results
From 2003 to 2007, there were 865 LAGB performed. We identified 17 operations performed for erosions in this period; some referred from elsewhere. Among these, an omental plugging technique was used in five patients (median preoperative body mass index 46.5; median age 47; all female). Median timing of presentation was 8 months, with pain/pyrexia in all five (with coexisting obstructive symptoms in four) patients. At endoscopy, three were posterior, partial erosions. Intraoperatively, all were partial erosions (three posterior and two anterior). In theater, we removed the band in all cases and closed the defect with a vascularized omental plug, fashioned using a harmonic scalpel. There were no immediate postoperative complications. On follow-up, two patients stayed the same weight, but in three, the weight increased leading to two needing rebands (at 6 and 8 months).
Conclusions
Omental plugging is a way of managing LAGB erosion, which in our hands has led to an uneventful postoperative course and future rebanding without undue delay. It is suited patients with incomplete erosion when the endoscopic option is difficult, thereby removing the need for a surveillance period awaiting complete band erosion.
Similar content being viewed by others
References
Belachew M, Legrand MJ, Defechereux TH, et al. Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity. A preliminary report. EcoHealth. 1994;8(11):1354–6.
Angrisani L, Furbetta F, Doldi SB, et al. Lap Band® adjustable gastric banding system. The Italian experience with 1863 patients on 6 years. EcoHealth. 2003;17(3):409–12.
O’Brien PE, Dixon JB. Weight loss and early and late complications—the international experience. Am J Surg. 2002;184(6B):42S–5.
Lattuada E, Zappa MA, Mozzi E, et al. Band erosion following gastric banding: how to treat it. Obesity Surgery. 2007;17(3):329–33.
Abu-Abeid S, Zohar DB, Sagie B, et al. Treatment of intra-gastric band migration following laparoscopic banding: safety and feasibility of simultaneous laparoscopic band removal and replacement. Obes Surg. 2005;15(6):849–52.
Iannelli A, Dahman M, Facchiano E, et al. A simple technique for laparoscopic removal of silicone adjustable gastric banding. J Laparoendosc Adv Surg Tech. 2006;16(3):301–4.
Niville E, Dams A, Vlasselaers J. Lap Band® erosion: incidence and treatment. Obes Surg. 2001;11(6):744–7.
Weiss H, Nehoda H, Labeck B, et al. Gastroscopic band removal after intra-gastric migration of adjustable gastric band: a new minimal invasive technique. Obes Surg. 2000;10(2):167–70.
Mittermair RP, Weiss H, Nehoda H, et al. Uncommon intra-gastric migration of the Swedish adjustable gastric band. Obes Surg. 2002;12(3):372–5.
Abu-Abeid S, Szold A. Laparoscopic management of lap-band erosion. Obes Surg. 2001;11(1):87–9.
Weber M, Müller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, not for re-banding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238(6):827–33.
Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: review of 70 patients. Obes Surg. 2004;14(10):1349–53.
de Cesepel J, Quinn T, Pomp A, et al. Conversion to laparoscopic bilio-pancreatic diversion with duodenal switch for failed laparoscopic adjustable silicone gastric banding. J Laparoendosc Adv Surg Tech. 2002;12(4):237–40.
Belachew M, Belva PH, Desaive C. Long term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg. 2002;12(4):564–8.
Favretti F, Cadière GB, Segato G, et al. Laparoscopic banding: selection and technique in 830 patients. Obes Surg. 2002;12(3):385–90.
O’Brien PE, Brown WA, Smith A, et al. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg. 1999;86(1):113–8.
Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid obesity. J Laparoendosc Adv Surg Tech. 1999;9(1):23–30.
Egbeare DM, Myers AF, Lawrance RJ. Small bowel obstruction secondary to intra-gastric erosion and migration of a gastric band. J Gastrointest Surg. 2008;12(5):983–4.
Rao AD, Ramalingam G. Exsanguinating hemorrhage following gastric erosion after laparoscopic adjustable gastric banding. Obes Surg. 2006;16(12):1675–8.
Abu-Abeid S, Keidar A, Gavert N, et al. The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity. EcoHealth. 2003;17(6):861–3.
Meir E, Van Baden M. Laparoscopic adjustable silicone gastric banding and band erosion: personal experience and hypothesis. Obes Surg. 1999;9(2):191–3.
Westling A, Bjurling K, Ohrvall M, et al. Silicone-adjustable gastric banding: disappointing results. Obes Surg. 1998;8(4):467–74.
Vertruyen M, Paul G. 11-cm Lap-Band® system placement after history of intragastric migration. Obes Surg. 2003;13(3):435–8.
Campos J, Ramos A, Galvão Neto M, et al. Hypovolemic shock due to intragastric migration of an adjustable gastric band. Obes Surg. 2007;17(4):562–4.
Fobi M, Lee H, Igwe D, et al. Band erosion: incidence, etiology, management and outcome after banded vertical gastric bypass. Obes Surg. 2001;11(6):699–707.
Author information
Authors and Affiliations
Corresponding author
Additional information
None of the authors have any vested commercial interests that could affect the contents of this manuscript.
Rights and permissions
About this article
Cite this article
Cherian, P.T., Goussous, G. & Sigurdsson, A. Management of Band Erosion with Omental Plugging: Case Series from a 5-Year Laparoscopic Gastric Banding Experience. OBES SURG 19, 1409–1413 (2009). https://doi.org/10.1007/s11695-009-9925-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-9925-4