• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Inability to Perform Laparoscopic Gastric Band Due to Hepatomegaly: A Single Institution Experience

George S Ferzli, MD, Abraham Fridman, DO, Michael F Timoney, MD, Sean Rim, MD. Lutheran Medical Center, Dept of Surgery, Brooklyn, NY

The use of Laparoscopic Banding (Lap Band) as a restrictive bariatric procedure has been widely accepted and studied. However, many questions still remain for the correct stratification of patients for this procedure. Some absolute contraindications to a Lap Band include psychiatric problems or mental disabilities that will not allow patients to comply with appropriate post band diet and exercise program, malignant hyperphagia, and severe portal hypertension. Previous foregut surgery, older age (>65), severe cardiovascular and pulmonary disease, and a BMI >50 are some of the relative contraindications. We believe that there is also a subset of patients with hepatomegaly who may not be safe candidates for a Lap Band.

We prospectively looked at all patients undergoing Lap Band placement at our institution over the last five years. We retrospectively analyzed the circumstances surrounding all patients who had aborted Lap Bands. All the patients underwent the standard preoperative work-up which included abdominal sonogram, Upper Gastrointestinal series/esophagogastroduadenoscopy, cardiac/pulmonary work up, a psychological evaluation, and lower extremity ultrasonography to evaluate the presence of DVT. The operative notes of all patients who had an aborted Lap Band were reviewed and the reason for aborting was noted.

A total of 673 patients underwent laparoscopic bariatric procedures over the last 5 years. 221 Lap Bands were performed with the standard pre-operative work-up which did not show any contraindications. In 19 of these patients (9%) the case was aborted due to intraoperative findings. The mean age of the patients was 46 (20-67), 11 were male and 8 were female, average BMI was 48 (39-62). The vast majority of patients (15 of 19) could not have Lap Band placement due to large liver size. 3 patients had large hiatal hernias and one case was aborted due to previous vertical banded gastroplasty with inability to visualize the anatomy. Out of the 19 patients, 6 (31%) returned to undergo a successful Laparoscopic Roux-en-Y gastric bypass (LRYGB). 5 out of those 6 patients were female. Of the remaining patients 7 were contacted and they were either unreachable via phone or mail and the others chose non-surgical options.

To our knowledge there are no other reports that describe aborted Lap Bands due to hepatomegaly. Hepatomegaly makes it difficult to visualize the window needed for Band placement which may make it unsafe. Ironically these patients may be better suited to undergo the more extensive LRYGB because in this procedure there is no need for a dangerous dissection posterior to the esophagus in the setting of an enlarged left hepatic or caudate lobe. Surgeons should be aware that significant hepatomegaly may be a contraindication to pursuing a Lap Band, 7% in our series. We suggest that part of the preoperative discussion with patients opting for a Lap Band should be the possibility of aborting the procedure because of hepatomegaly. Furthermore patients and surgeons should understand that a LRYGB may be a safe surgical alternative in the future for those who can not undergo a safe Lap Band placement.


Session: Poster
Program Number: P072
View Poster

113

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons