Geoffrey P Kohn, MBBS, Cheryl Hansen, RN, Richard W Gilhome, MBBS, Ray C McHenry, MBBS, Chris Hensman, MBBS. LapSurgery Australia
Intragastric erosion is a rare but major complication of laparoscopic adjustable gastric band (LAGB) surgery for morbid obesity. Many techniques have been described to treat this problem, with little supporting evidence.
One described technique is endoscopic removal of the band. Endoscopic removal is only feasible when the buckle of the device becomes intraluminally situated. Endoscopic treatment has often to be delayed to allow the buckle to appear within the lumen of the stomach for removal using this technique. Alternatives include a laparoscopic approach, whether from outside the stomach or through planned gastrotomy.
We have reviewed our experience with laparoscopic removal of eroded gastric band, investigating safety, time to removal and outcomes.
METHODS AND PROCEDURES
Our practice’s prospectively collected bariatric surgery database was queried for the period January 2000 until September 2010. The medical records were reviewed for all patients with the diagnosis of band erosion. Symptoms, time to erosion, interval between diagnosis and treatment, and complications of treatment were reviewed. All patients had laparoscopy, partial take-down of the gastrogastric plication, cut-down onto the band, division of the band near the buckle, removal of the band and primary closure of the gastrotomy with omental patch reinforcement as required.
A total of 2032 LAGB operations were performed during the study period. Of these 44 (2.2%) resulted in intragastric erosion. All bands placed were LapBands – 11 erosions were of the 10cm band, 10 with the Vanguard, 10 with the AP small and 13 with the AP large.
Three patients elected to have their revisional surgery elsewhere and were lost to follow-up. Forty-one patients were included in the analysis. Mean time from band placement to the diagnosis of erosion was 33.1 months, and mean time from diagnosis to removal was 17 days. Mean hospital length of stay was 5 days (mode 2, median 4). There was one postoperative leak, one superficial wound infection and one pleural effusion. There were no deaths.
The safety of laparoscopic removal of eroded gastric bands with primary closure and omental patch repair is demonstrated.
The time from diagnosis of erosion to treatment can be short, in contrast to endoscopic removal where often the requirement for further erosion of the band to free the buckle necessitates delayed treatment.
Program Number: S068