Laparoscopic Repair of Banded Gastric Bypass Pouch Obstruction

Ray King, MD, PhD, Sean Lee, MD, Amy Biedenbach, MS, PAC, Brian Lane, MD, FACS. Medical College of Georgia, Georgia Regents University.

Placement of a silastic band at the gastric pouch as part of a Roux-en-Y gastric bypass surgery for obesity can lead to proximal obstructive symptoms.  Luminal narrowing at the silastic band can cause nausea, vomiting, abdominal pain, and significant malnutrition. These band-related complications are difficult to diagnose. Obstructive symptoms are often inaccurately attributed to strictures at the gastrojejunostomy anastomosis, leading to multiple unnecessary and unsuccessful attempts at endoscopic dilation. 

We report on the diagnosis, management, and laparoscopic repair of gastric pouch obstructive symptoms secondary to non-adjustable gastric band placement.  We demonstrate that laparoscopic excision of the silastic band, with intra-operative endoscopy, is feasible, safe, and will provde immeidate and adequate relief of obstructive symptoms

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