Laparoscopic Transgastric EGD-guided removal of a gastric band with complete erosion of the stomach wall

Bestoun H Ahmed, MD, FRCS, FACS, Abubaker Ali, MD, Ziad Awad, MD, Michael Latzko, MD, Michael Nussbaum, MD, FACS. UF COM-Jacksonville FL

A 33-year-old female patient presented to the bariatric clinic with repeated episodes of epigastric pain and intolerance to solid food in the last several months. She had a gastric band placed in 2011. She lost 40% of her excess weight and she regained ½ of it. She is still morbidly obese (BMI:58.56) and H/O HTN, Asthma, and DJD. UGI and CT scan were both Suggestive for Band erosion.

EGD showed erosion of most of the band ring except the buckle which was still covered by a layer of mucosa. Laparoscopic lysis of adhesions is performed and the left lobe of the liver is release from the band attachments.  Adhesions to the anterior aspect of proximal stomach are taken down and a longitudinal gastrotomy is made. The band was intraluminal. The band is grasped divided using endoshears. The mucosa covering the buckle is coagulated and the band is dislodged and taken out of the stomach. It is unbuckled there and taken out through the 12 mm port. An EGD guided leak test is performed and a drain is placed under the left lobe of the liver.

Operative time was 45 minutes. She was out of bed same day of the procedure and tolerated oral intake. She was discharged home at postoperative day #1. She was followed in the clinic with good recovery. It is planned to switch to a Gastric Bypass in few months.

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