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Robotic-Assisted Gastric Band Removal of a Complete Band Erosion

Mario Masrur, MD, Pablo Quadri, MD, Luis Fernando Gonzalez-Ciccarelli, MD, Lisa Sanchez-Johnsen, PhD, Pier Giulianotti, MD, FACS. University of Illinois Hospital and Health Sciences System

Introduction: Over the past decade, Laparoscopic Adjustable Gastric Banding (LAGB) has been a popular procedure in the U.S. and Europe. However, the current use of LAGB has declined. Although the exact reasons for the decline in this surgical procedure have not been studied directly, there are high rates of reoperation, weight regain and complications associated with LAGB. Band erosion (BE) is a rare but serious complication after LAGB with an incidence rate of 1.46%. The aim of this case report video is to show the removal of a complete BE using a minimally invasive (MI) robotic approach.

Case presentation: This patient was a 54-year-old woman with non-significant past medical history who underwent a LAGB eight years prior to the band removal. The patient did not follow up in our clinic and presented to the clinic 8 years post-LAGB with abdominal pain and an upper GI fluoroscopy showed an abnormal band positioning. A CT scan showed a complete (100%) BE with the band migrated into the stomach lumen. The patient was offered the option of undergoing an endoscopic band removal with the possibility of a MI robotic approach if the endoscopic removal failed. A preoperative EGD showed a complete BE, but the band could not be removed endoscopically due to firm adhesions. An open removal of the port was performed. A MI robotic approach was then utilized. A diagnostic laparoscopy was performed, adhesions from the omentum to the liver and stomach were lysed. The band tubing was followed with removal of some adhesions. A 4 cm longitudinal anterior gastrotomy including the eroded opening in the stomach was performed, and the band was removed from inside the stomach lumen. The anterior gastrotomy was closed with a double layer of running 3.0 PDS. The tubing fistula track was closed with 3.0 PDS. An intra-operative EGD and an air leak test were performed to assess the closure with no evidence of leak. The patient’s symptoms improved dramatically after surgery and the diet was tolerated. The patient was discharged on POD 1 and presented no complications after two months of follow up.

Conclusions: In this case report, a MI robotic approach provided the opportunity to remove the band and repair the fistula with a prompt recovery and no morbidity. In this complete band erosion, a MI robotic approach was safely used to manage this severe complication after an endoscopic approach failed to remove the band.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80379

Program Number: V212

Presentation Session: Video Loop

Presentation Type: VideoLoop

163

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