Repositioning the Lap-Band for proximal pouch dilatation.
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) procedures have proved their efficiency and reproducibility in several studies. The most frequent late complication is proximal pouch dilatation, with possible progression to total food intolerance.


METHODS
In a series of 727 laparoscopic bandings using the Lap-Band System, 54 patients presented proximal pouch dilatation and required laparoscopic reposition of the band. 2 patients who had had LAGB placed in another hospital received the same treatment.


RESULTS
No particular intra- or postoperative complications occurred during laparoscopic repositioning of the band. 2 conversions were necessary in the beginning of the experience to safely unlock the band. After a median follow-up of 74 months, there has been no recurrence of proximal dilatation.


CONCLUSIONS
Laparoscopic repositioning of the Lap-Band System for proximal pouch dilatation is a safe and reproducible procedure which can be proposed as an interesting alternative to its replacement by a new one. An initial perigastric placement of the band allows, during the redo, safe dissection in a virgin pars flaccida tunnel. The calibration of the tiny proximal pouch, the presence of postoperative adhesions, and maintainance of strict control of dietary behavior are probably the reasons for the absence of recurrence of pouch dilatation.
Vertruyen
Marc
M
Department of Laparoscopic Gastrointestinal Tract Surgery, Europe St-Michel Clinic, Brussels, Belgium. marcvertruyen@belgacom.net
D000293:Adolescent; D000328:Adult; D004108:Dilatation, Pathologic; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation