The application of the nonadjustable gastric band for the treatment of morbid obesity was common in the 1980s. Unfortunately, it was associated with an unacceptable re-operative rate with numerous post-operative complications such as gastric erosion. Removing an eroded gastric band is fraught with difficulty secondary to the extensive inflammatory response around the proximal stomach and left lobe of the liver. To circumvent these difficulties, we have devised a trans-gastric endoscopic rendez-vous (TGER) technique for the removal of eroded non-adjustable Molina gastric bands.
A retrospective review of two patients who underwent the TGER technique for removal of an eroded non-adjustable gastric Molina band was undertaken. The outcomes assessed include the pre-operative morbidity, a description of the surgical procedure, and the post-operative course.
Both patients presented with symptoms consistent with a proximal gastric outlet obstruction. The TGER technique was effectively applied in removing the eroded gastric band in both patients with no intraoperative, perioperative or postoperative complications (6 month follow-up). Furthemore, one patient requested further treatment for morbid obesity and subsequently underwent succesful placement of an adjustable gastric band.
The TGER technique is a safe and effective procedure applicable to the complicated case of an eroded non-adjustable gastric band. Utilization of a combined endoscopic/transgastric approach facilitates complete avoidance of the thick adhesion surrounding the previously banded stomach with the capability to secure a gastrotomy in virgin tissue rather than opening and then closing the dense perigastric pseudo-capsule. Nevertheless, the true utility of the TGER technique is soundly dependent on adequate resource availability and experienced surgical assistance and needs to be further explored.
Program Number: P013