Reducing the incidence of gastric prolapse after adjustable banding: A stitch away

Background: Laparoscopic adjustable gastric banding is gaining in popularity for the treatment of morbid obesity. While it garners successful weight loss, the postoperative course can be complicated by reoperations. Gastric prolapse after adjustable banding is the most common cause for reoperation, approaching up to 5% in many series. Using the Pars Flaccida technique, it is the anterior or anterolateral fundus that prolapses cephalad thru the band. In an attempt to reduce the incidence of gastric prolapse, an anterior plication of the fundus below the band was performed. This study examines the effect of this plication on the incidence gastric prolapse. Methods: A retrospective review of a prospectively maintained database was performed. 479 patients were identified that underwent laparoscopic adjustable banding between January 2001 to September 2007. The patients were divided into two groups: Group A, patients who did not have a plication and Group B, patients who did have a plication. Group A patients were operated on between January 2001 until December 2002. Group B patients were operated on from January 2003 until September 2007. Main outcomes measured were incidence of gastric prolapse, time to gastric prolapse and duration of follow-up. Statistical analysis was performed using the Fishers Exact test. Results: 16 patients underwent reoperation for gastric prolapse for an overall rate of 3.35%. Group A consisted of 108 patients with 13 patients with gastric prolapse (12%). Group B had 371 patients with 3 patients with gastric prolapse (0.8%). Mean interval to gastric prolapse in Group A was 21 months (range 4-61 months) and in Group B, the mean interval was 17 months (range 7-26 months). Mean duration of follow-up is greater in Group A (55.8 months, range 58-80) than Group B (25.3 months, range 1-57) and this is due to the study parameters. Group A also represents part of the learning curve for gastric banding. There is a significant difference in the gastric prolapse rate between Group A and Group B (p

Session: Poster

Program Number: P062