Gastric plication can reduce slippage rate after laparoscopic gastric banding

A Hussain, H Mahmood, S El-Hasani, A Hussain, H Mahmood, S El-Hasani

Abstract

Background: Laparoscopic insertion of a gastric band for weight reduction is increasingly performed in obese and morbidly obese patients. Complication rates after gastric band insertion are reduced by using certain techniques.

Patients and methods: This was a prospective study of all patients who underwent laparoscopic adjustable gastric band (LAGB) insertion at our unit. This procedure is performed through the classical 4-port technique and the use of a liver retractor. The pars flaccida method is performed in all patients, and the gold finger, a malleable instrument, is used to guide the band through the retroesophageal window in patients with difficult anatomy. Band slippage is avoided by using 2 types of gastric plication, depending on the anatomical characteristics of the stomach. Outcomes and morbidity are recorded, and patients are followed up in outpatient clinics.

Results: Laparoscopic adjustable gastric band (LAGB) insertion was performed in 464 patients. A single consultant surgeon performed all procedures over a 2-year period. From August 2005 through August 2007, 380 (81.89%) women and 84 (18.10%) men were included in this study. The mean age was 41 years (range, 21 to 62). The mean body mass index was 43 (range, 35 to 62). Morbidity included dysphagia, epigastric pain, port displacement, port infection, erosion, and acute respiratory distress. Only one (0.21%) case of band slippage was reported. The mean follow-up was 26 months (range, 18 to 42).

Conclusion: Laparoscopic gastric plication adds greater security and provides optimum gastric band placement. It is an effective method to reduce slippage after gastric band insertion.

Figures

Figure 1.
Figure 1.
Longitudinal plication, first step.
Figure 2.
Figure 2.
Longitudinal plication, final step.
Figure 3.
Figure 3.
Transverse plication, first step.
Figure 4.
Figure 4.
Transverse plication, final step.
Figure 5.
Figure 5.
Oblique plication, first step.
Figure 6.
Figure 6.
Oblique plication, final step.
Figure 7.
Figure 7.
Schematic representation of different types of plication, LP=longitudinal plication, TP=transverse plication, OP= oblique plication.

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Source: PubMed

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