title: Reduction in slippage with 11-cm Lap-Band and change of gastric banding technique.
abstract: BACKGROUND
  Slippage occurs after 2-18% of gastric bandings performed by the perigastric technique (PGT). We investigated the slippage-rate before and after the introduction of the pars flaccida technique (PFT) and the 11-cm Lap-Band, and the long-term results of the re-operated patients.
  
  
  METHODS
  Between Dec 1996 and Feb 2004, 360 patients with a mean BMI of 44 kg/m2 were operated. The PGT (n=168) and PFT9.75 (n=15) groups received the 9.75-cm Lap-Band, and the PFT11 group (n=177) received the new 11-cm Lap-Band. Follow-up rate was 99%.
  
  
  RESULTS
  Slippage occurred in a total of 31 patients from all groups (PGT, n=28, or 17%; PFT9.75, n=1, or 7%; PFT11, n=2, or 1%). Average yearly re-operation rate for slippage in the first 3 years postoperatively was 3.8%, 2.2% and 0.9%, respectively. Laparoscopic re-banding was necessary for posterior (n=19) or lateral (n=12) slippage. The late postoperative course after re-banding was: uneventful 58%, weight regain 35% and/or esophageal motility disorder 23%, secondary band intolerance 20%, and one persistent posterior slippage. 8 patients (26%) needed biliopancreatic diversion.
  
  
  CONCLUSIONS
  Since the introduction of the PFT and the 11-cm Lap-Band, we observed a significant reduction in slippage rate and no posterior slippage. Re-banding had a less favorable long-term result than did first-procedure banding.
authors.affiliation: Surgical Clinic, St. Claraspital, Basel, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Wölnerhanssen
authors.forename: B
authors.initials: B
authors.lastname: Kern
authors.forename: T
authors.initials: T
authors.lastname: Peters
authors.forename: C
authors.initials: C
authors.lastname: Ackermann
authors.forename: M
authors.initials: M
authors.lastname: von Flüe
authors.forename: R
authors.initials: R
authors.lastname: Peterli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control*; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D011475:Prosthesis Failure; D016896:Treatment Outcome