David Czeiger1, Shadi Abu-Swis2, Gad Shaked3, Amnon Ovnat3, Gilbert Sebbag3. 1. Department of General Surgery, Soroka University Medical Center and Ben Gurion University, Beer Sheva, 84101, Israel. czeiger@bgu.ac.il. 2. Department of General Surgery, Soroka University Medical Center, Beer Sheva, 84101, Israel. 3. Department of General Surgery, Soroka University Medical Center and Ben Gurion University, Beer Sheva, 84101, Israel.
Abstract
BACKGROUND: Optimal adjustment of the filling volume of laparoscopic adjustable gastric banding is challenging and commonly performed empirically. Patients with band over-inflation and gastric obstruction arrive at the emergency department complaining of recurrent vomiting. In cases of gastric obstruction, intra-band pressure measurement may assist in determining the amount of fluid that should be removed from the band; however, our investigations have determined that intra-band pressure assessment need not play a role in the treatment of gastric band obstruction. METHODS: In patients coming to the emergency department with gastric band obstruction, we measured intra-band pressure at arrival and following stepped removal of fluid, comparing the initial pressure with post-deflation pressure and measuring the volume of fluid removed. RESULTS: Forty-eight patients participated in the study. Forty-five patients had a low-pressure/high-volume band. Their mean baseline pressure was 54.6 ± 22.3 mmHg. The mean volume of fluid removed from the band was 1.3 ± 0.8 ml. The mean post-deflation pressure was 22.5 ± 16.3 mmHg. Nearly 30 % of patients required as little as 0.5 ml of fluid removal, and 60 % of them were free of symptoms with removal of 1 ml. CONCLUSIONS: Our results indicate that intra-band pressure measurement is of little value for determining the amount of fluid that should be removed for treatment of band obstruction. We suggest the removal of fluid in volumes of 0.5 ml until symptoms are relieved. Only in complicated cases, such as in patients having recurrent obstructions, should additional modalities be employed for further management guidance.
BACKGROUND: Optimal adjustment of the filling volume of laparoscopic adjustable gastric banding is challenging and commonly performed empirically. Patients with band over-inflation and gastric obstruction arrive at the emergency department complaining of recurrent vomiting. In cases of gastric obstruction, intra-band pressure measurement may assist in determining the amount of fluid that should be removed from the band; however, our investigations have determined that intra-band pressure assessment need not play a role in the treatment of gastric band obstruction. METHODS: In patients coming to the emergency department with gastric band obstruction, we measured intra-band pressure at arrival and following stepped removal of fluid, comparing the initial pressure with post-deflation pressure and measuring the volume of fluid removed. RESULTS: Forty-eight patients participated in the study. Forty-five patients had a low-pressure/high-volume band. Their mean baseline pressure was 54.6 ± 22.3 mmHg. The mean volume of fluid removed from the band was 1.3 ± 0.8 ml. The mean post-deflation pressure was 22.5 ± 16.3 mmHg. Nearly 30 % of patients required as little as 0.5 ml of fluid removal, and 60 % of them were free of symptoms with removal of 1 ml. CONCLUSIONS: Our results indicate that intra-band pressure measurement is of little value for determining the amount of fluid that should be removed for treatment of band obstruction. We suggest the removal of fluid in volumes of 0.5 ml until symptoms are relieved. Only in complicated cases, such as in patients having recurrent obstructions, should additional modalities be employed for further management guidance.
Authors: Paul Robert Burton; Wendy A Brown; Cheryl Laurie; Melissa Richards; Geoff Hebbard; Paul E O'Brien Journal: Obes Surg Date: 2009-11 Impact factor: 4.129
Authors: Benjamin K Poulose; Michael D Holzman; Yuwei Zhu; Walter Smalley; William O Richards; J Kelly Wright; Willie Melvin; Marie R Griffin Journal: J Am Coll Surg Date: 2005-07 Impact factor: 6.113
Authors: Wolfgang Lechner; Michael Gadenstätter; Ruxandra Ciovica; Werner Kirchmayr; Gerhard Schwab Journal: Obes Surg Date: 2005 Nov-Dec Impact factor: 4.129
Authors: J S Burgerhart; E O Aarts; P C van de Meeberg; F J Berends; P D Siersema; A J P M Smout Journal: Neurogastroenterol Motil Date: 2013-03-27 Impact factor: 3.598
Authors: Thomas P Rauth; Aaron W Eckhauser; Bonnie J LaFleur; Willie V Melvin; Michael D Holzman Journal: J Am Coll Surg Date: 2008-03-17 Impact factor: 6.113
Authors: James Toouli; Lillian Kow; Almino C Ramos; Franz Aigner; Piet Pattyn; Manoel P Galvão-Neto; Karl A Miller; Stefania Romano; Mario Gutierrez; Jeremy Jokinen Journal: Surg Obes Relat Dis Date: 2009-05-05 Impact factor: 4.734