Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications.
BACKGROUND
The laparoscopic application of LAP-BAND is gaining widespread acceptance as a gastric restrictive procedure. At the same time the reported morbidities (i.e., gastric perforation, stomach and/or band slippage) are cause for some concern.


METHODS
From September 1993 until May 1997, 260 patients underwent LAP-BAND at the Department of Surgery at the University of Padova, Italy.


RESULTS
The mortality rate was zero and the morbidity rate requiring reoperation was 3.4% (stomach slippage, gastric perforation, erosion). In order to avoid complications the key points of the technique are reviewed: (1) reference points for dissection (equator of the balloon, left crus); (2) retrogastric tunnel within the layers of the phrenogastric ligament; (3) embedment of the band; (4) proper outlet calibration; and (5) retention sutures.


CONCLUSIONS
Attention to technical details is of paramount importance for a safe, standardized and effective operation.
Favretti
F
F
Department of Surgery, University of Padova, Italy.
Cadiere
G B
GB
Segato
G
G
Himpens
J
J
Busetto
L
L
De Marchi
F
F
Vertruyen
M
M
Enzi
G
G
De Luca
M
M
Lise
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D004210:Dissection; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008022:Ligaments / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D012828:Silicones; D013270:Stomach / Q000293:injuries / Q000473:pathology; D013536:Suture Techniques
D012828:Silicones