Obstructive symptoms associated with the 9.75-cm Lap-Band in the first 24 hours using the pars flaccida approach.
BACKGROUND
For some patients, especially those with a higher BMI, a non-selective Lap-Band placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours.


METHODS
Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow.


CONCLUSIONS
Obstructive symptoms associated with the Lap-Band using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band for the pars flaccida approach could easily prevent this early complication.
Bernante
Paolo
P
Department of Medical and Surgical Sciences, Surgical Pathology, Padua University Hospital, Italy. paolo.bernante@unipd.it
Francini Pesenti
Francesco
F
Toniato
Antonio
A
Zangrandi
Fabio
F
Pomerri
Fabio
F
Pelizzo
Maria Rosa
MR
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology; D004487:Edema / Q000209:etiology; D004867:Equipment Design; D004940:Esophageal Stenosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D013272:Stomach Diseases / Q000209:etiology