Codification of techniques for reoperation after Lap-Band.
BACKGROUND
The Lap-Band is a safe, reversible, minimally invasive, and effective bariatric technique, whose main late complications are herniation/dilation of the pouch, erosion/migration of the band, and problems with the adjustment system (subcutaneous access port and connection tubing). We describe the surgical timing and techniques for dealing with the principal complications.


METHODS
Between October 1995 and September 2001, we treated 540 patients (mean age 43 years, mean BMI 42.6 kg/m(2)). All operations were completed laparoscopically, with no intra-operative complications or mortality. Late complications were: problems with the band adjustment system (n=35); herniation/dilations of the pouch (n=14); erosions/migration of the band into the stomach (n=3).


RESULTS
We dealt successfully with all complications using a minimally invasive technique. Herniation/dilations of the pouch necessitated 15 successful repositionings of the band, and 2 removals of the band at the patients' request. Erosion/migration was treated by endo-laparoscopic band removal. Problems with the band adjustment system had to be corrected laparoscopically, under general anesthesia in 17 patients.


CONCLUSIONS
While emphasizing the rarity of complications, we have codified re-operation techniques to help Lap-Band users solve them using a minimally invasive procedure. In particular, problems with the port and connection tubing system can be completely avoided with a transverse subcutaneous positioning in a straight line.
Department of Surgery, Ospedale di Pescia (PT)-ASL3, Pistoia, Italy. f.furbetta@virgilio.it
Francesco
F
Furbetta
Elisabetta
E
Coli
D000328:Adult; D000368:Aged; D004108:Dilatation, Pathologic; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation