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Does Adding a Lesser Curvature Gastro-Gastric Plication Suture Reduce the Need for Revision After Laparoscopic Adjustable Gastric Band Placement?

J Zagzag, MD, B Schwack, MD, H Youn, MA BSN, C Ren-Fielding, MD, G Fielding, MD, M Kurian, MD. NYU Langone Medical Center

Introduction: The need for revision after laparoscopic adjustable gastric band (LAGB) surgery has been greatly reduced over the last 10 years with the introduction of the pars flaccida technique, with slow and steady band tightening, and with concurrent repair of any hiatal hernias. However, band revision still occurs in up to 5% of patients. A lesser curvature, gastro-gastric suture distal to the band is one newer technique suggested to lower band slippage. We have looked at 2 groups of patients in our practice to evaluate its worth: one group with and one group without the plication stitch.

Methods: This is a retrospective review of data on 1,365 LAGB patients collected prospectively on an IRB approved data base between July 2007 and May 2010. One surgeon did not perform the plication stitch (n=776) and one did (n=589). Surgical techniques were otherwise very similar. The majority of these patients had crural repair at primary band placement. The data was assessed for rates of band revision.

Results: LAGB was performed safely in 1,365 patients with a mean follow-up of 22 months. The two groups were similar. The non-stitch group consisted of 776 patients, with 496 females (64%). This group’s mean age was 42 years, mean weight of 278 lbs, and mean BMI 44.6 kg/m². The stitch group consisted of 589 patients, with 426 females (72%). This group’s mean age was 40 years, mean weight of 278 lbs, and mean BMI 44.8 kg/m². The no-stitch group had 44% EWL at 12 months and 50% EWL at 2 yrs; the stitch group had 37% EWL at 12 months and 45% EWL at 2 years.
Both groups had very low revision rates. The no-stitch group had 4 revisions in 776 patients (0.26%). The stitch group had 9 revisions in 589 patients (1.5%).

Table I
Post-op problem No problem noted Band intolerance Band slippage Band slippage w/ hiatal hernia Dysphagia GERD Band Revision Total Total Case Number
No stitch 772 0 1 1 1 1 4 776
Pliation Stitch 580 1 0 6 1 1 9 589

Conclusion: Adding a lesser curvature gastro-gastric plication suture offers no added benefit in reducing the rate of revision after LAGB surgery.

Session: SS12
Program Number: S071