P Thomas Cherian1, G Goussous, A Sigurdsson. 1. Shropshire Upper GI and Laparoscopic Surgery Unit, Princess Royal Hosptial, Telford, TF6 1TF, England, UK. liversurg@live.co.uk
Abstract
BACKGROUND: Although reports on band erosion management after laparoscopic adjustable gastric banding (LAGB) agree that in most cases the affected band will need to be removed, there is no consensus on the technique of removal. We report a minimalistic, laparoscopic technique which is safe and avoids management delay. METHODS: We retrospectively reviewed the operative log of our obesity surgery unit to find all operations performed on LAGB patients for erosion from Jan 2003 to Dec 2007. The cases that underwent this particular technique were identified. Case notes and electronic records were then reviewed for postoperative morbidity and outcomes. The operative technique and indications of this particular method is described which to our knowledge has not been reported before. RESULTS: From 2003 to 2007, there were 865 LAGB performed. We identified 17 operations performed for erosions in this period; some referred from elsewhere. Among these, an omental plugging technique was used in five patients (median preoperative body mass index 46.5; median age 47; all female). Median timing of presentation was 8 months, with pain/pyrexia in all five (with coexisting obstructive symptoms in four) patients. At endoscopy, three were posterior, partial erosions. Intraoperatively, all were partial erosions (three posterior and two anterior). In theater, we removed the band in all cases and closed the defect with a vascularized omental plug, fashioned using a harmonic scalpel. There were no immediate postoperative complications. On follow-up, two patients stayed the same weight, but in three, the weight increased leading to two needing rebands (at 6 and 8 months). CONCLUSIONS: Omental plugging is a way of managing LAGB erosion, which in our hands has led to an uneventful postoperative course and future rebanding without undue delay. It is suited patients with incomplete erosion when the endoscopic option is difficult, thereby removing the need for a surveillance period awaiting complete band erosion.
BACKGROUND: Although reports on band erosion management after laparoscopic adjustable gastric banding (LAGB) agree that in most cases the affected band will need to be removed, there is no consensus on the technique of removal. We report a minimalistic, laparoscopic technique which is safe and avoids management delay. METHODS: We retrospectively reviewed the operative log of our obesity surgery unit to find all operations performed on LAGB patients for erosion from Jan 2003 to Dec 2007. The cases that underwent this particular technique were identified. Case notes and electronic records were then reviewed for postoperative morbidity and outcomes. The operative technique and indications of this particular method is described which to our knowledge has not been reported before. RESULTS: From 2003 to 2007, there were 865 LAGB performed. We identified 17 operations performed for erosions in this period; some referred from elsewhere. Among these, an omental plugging technique was used in five patients (median preoperative body mass index 46.5; median age 47; all female). Median timing of presentation was 8 months, with pain/pyrexia in all five (with coexisting obstructive symptoms in four) patients. At endoscopy, three were posterior, partial erosions. Intraoperatively, all were partial erosions (three posterior and two anterior). In theater, we removed the band in all cases and closed the defect with a vascularized omental plug, fashioned using a harmonic scalpel. There were no immediate postoperative complications. On follow-up, two patients stayed the same weight, but in three, the weight increased leading to two needing rebands (at 6 and 8 months). CONCLUSIONS: Omental plugging is a way of managing LAGB erosion, which in our hands has led to an uneventful postoperative course and future rebanding without undue delay. It is suited patients with incomplete erosion when the endoscopic option is difficult, thereby removing the need for a surveillance period awaiting complete band erosion.