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Vagal nerve blocking device explantation: case series and report of operative technique

Tarin C Worrest, MD1, Bruce M Wolfe, MD1, Samer G Mattar, MD2, Erin W Gilbert, MD1. 1Oregon Health and Sciences University, 2Swedish Medical Center

Introduction: Vagal nerve blockade with the vBloc device (Enteromedics, St. Paul, MN) has been shown to provide sustained weight loss for patients with moderate obesity at two years. These devices occasionally require removal, however, there have been no published technical recommendations for the safe extraction of these devices. We present a series of patients who have undergone vagal blocking device removal, and report our technique for laparoscopic removal of this device.

Methods and Procedures: The medical records of all patients who underwent laparoscopic explantation of a vagal blocking device at a single academic institution from December 2009 to December 2016 were retrospectively reviewed.  All patients underwent device placement as part of a multi-center randomized controlled trial.  Operative details, length of stay, 30-day post-operative complications and indications for removal were reported. Details of the technical aspects of explantation were carefully examined and reported. In all cases, the device was dissected out using firm traction applied to the lead to elevate it away from the stomach and esophagus, as the device tended to form a dense, fibrotic capsule. The device was removed entirely, unless dense adhesions prevented safe dissection of the most distal tip of the device. Patient demographics, comorbidities, clinical characteristics and perioperative details were collected.

Results: Thirty patients were identified. Median age was 54 (37-65) years. Median operative time was 210 (101-498) minutes and median EBL was 28 (5-200) mL. Median time from initial implantation to removal was 41 (11-96) months.  Patient-reported reasons for removal included device malfunction (7 patients, 23.3%), neuroregulator site pain (5 patients, 16.7%), heartburn symptoms (11 patients, 36.7%), weight regain or weight loss dissatisfaction (15 patients, 50%), and severe nausea (2 patients, 6.7%). Thirteen patients had dense adhesions at the time of operation (43.3%). One patient had device erosion into the proximal stomach, which was repaired primarily. The highest Clavien-Dindo grade complication was grade II, (2 patients, 6.7%): one superficial trocar site infection and one intraabdominal abscess requiring IV antibiotics. Seroma at the neuroregulator site was the most common complication (7 patients, 23.3%).

Conclusion: The vagal nerve blocking device can be safely removed laparoscopically in the hands of experienced foregut surgeons with low 30-day complication rate. Surgeons planning device extraction should be familiar with the details of the configuration and location of the leads, and expect to encounter dense adhesions around the device.


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

Abstract ID: 86512

Program Number: P584

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

34

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