title: Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) has commonly been complicated by the problem of band slippage or prolapse. Since popularization of the pars flaccida approach and improved anterior fixation, it is our impression that the problem of symmetrical dilatation of the proximal gastric pouch has become more important.
  
  
  METHODS
  We have reviewed the results of a series of 425 LAGB all performed by the pars flaccida approach from June 2003 to October 2007 to analyze the incidence and implications of this new pattern.
  
  
  RESULTS
  There were no posterior prolapses, 2 anterior prolapses, and 17 cases of symmetrical pouch dilatation (SPD) (revision rate 4.4%). Teenage patients had a 22% revision rate for SPD. All revisions were completed laparoscopically with no mortality, no significant complications, and a median hospital stay of 1 day. The median weight loss following revisional surgery was not significantly different from the background cohort.
  
  
  CONCLUSIONS
  SPD is the most common reason for revision of LAGB in this series. We postulate that SPD is caused by excessive pressure in the proximal gastric pouch. This may be generated either by eating too quickly or too large a volume or excessive tightening of the band. The radial forces in the pouch may ultimately cause pressure on the phrenoesophageal ligament and a secondary hiatal hernia.
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Australia, Wendy.Brown@med.monash.edu.au
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
authors.forename: Paul R
authors.initials: PR
authors.lastname: Burton
authors.forename: Margaret
authors.initials: M
authors.lastname: Anderson
authors.forename: Anna
authors.initials: A
authors.lastname: Korin
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hebbard
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D013271:Gastric Dilatation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult