Feasibility of Intraoperative Gastric Band (GB) Adjustment with the Endoflip System

Ashraf Haddad, MD, Dominic Nelson, MS, Murad Bani Hani, MD, Andrew Averbach, MD, FACS

St. Agnes Hospital

Intraoperative gastric band GB adjustment generally has been avoided due to the risk of early obstruction. Most surgeons adjust the GB at 4-6 weeks after surgery. The Endoluminal Functional Lumen Imaging Probe (EndoFLIP) has been suggested for intraoperative calibration of the stoma. This study was aimed to evaluate the safety and efficacy of this technique.

Fifty consecutive patients, who had GB placed between march 2011 to april 2012, underwent attempted intraoperative band calibration with the EndoFLIP system. Before closure of the GB buckle the EndoFLIP probe was placed across the anticipated GB position. The port was accessed and the EndoFLIP system was used to measure the cross sectional diameter of the stoma and adjusted to a goal of <5.5 mm. Data analysis included patients demographics, weight , body mass index (BMI), postoperative dysphagia rate, time to first adjustment, and the percentage of excess body weight loss( %EBWL) during the first year. For the first year, patients were followed on a monthly basis with GB adjustment as needed to achieve continuous weight loss.

Fifty patients underwent adjustment using the EndoFLIP probe. Patients’ demographics did not differ from known averages. The mean preoperative weight was of 269 ± 44 lb and the mean preoperative body mass index was 43.7 ± 5.7. Failure to deploy catheter occurred in 4 % of patients. The stoma was calibrated to an average diameter of 5.2 ± 4 mm with an average final intraoperative band volume of 2.1 ±1.4 mls. One patient (2 %) developed transient mild odynophagia which resolved spontaneously on the second postoperative day without the need for further intervention or band deflation. There was no other morbidity. The average time to first postoperative GB adjustment was 8.5 weeks. Average follow-up was 7.3 months. Follow-up data at 3 months was available for 64 % of subjects. At 6 months and 1 year follow up was available for 78% and 79% of patients respectively. At 2 weeks, 4 weeks, 2 and 3 months % EBWL was 12.8%, 17.3%, 22.1% and 24%. At further follow up at 6 months and 1 year weight loss has increased to %EBWL of 34.3% and 48.4%, respectively.

Intraoperative GB adjustment with the EndoFLIP system appears to be safe and associated with minimal risk of early GB obstruction. Follow-up data, %EBWL suggest improved outcome.

Session: Poster Presentation

Program Number: P415

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