title: Subfascial port placement in gastric banding surgery.
abstract: BACKGROUND
  In some bariatric patients with predominantly intra-abdominal fat a shallow fat layer separates the gastric band access port from the skin. We hypothesise that subfascial port placement in these patients reduces skin erosions and port infections and improves cosmesis as weight loss occurs.
  
  
  OBJECTIVE
  This study aims to compare port complications, cosmetic outcome and ease of band adjustment with access ports in front of or behind the rectus muscle.
  
  
  METHODS
  We retrospectively compared complications and cosmetic outcomes of patients with subfascial ports to a control group matched for gender, BMI and age. Each subject completed a questionnaire utilising a 1 to 10 scale for nine parameters related to comfort and cosmesis and two parameters related to discomfort during adjustments.
  
  
  RESULTS
  Sixty-eight patients with subfascial ports were identified and the overall response rate was 84%. The groups were well matched for gender (m:f ratio 1.8:1 vs. 1.7:1, p = 1.000), age (51.0 vs. 49.6 years, p = 0.528) and BMI (39.8 vs. 40.3 kg/m², p = 0.585). There was no difference in port infection rates (0/68 vs. 1/68, p = 1.000) but the subfascial group had more hernias (3/68 vs. 0/68, p = 0.244). Subfascial patients experienced more pain during adjustments (score 4.3 vs. 2.6, p = 0.047) but a combined analysis of cosmesis showed a slight positive trend (1.58 vs. 1.76, p = 0.379).
  
  
  CONCLUSIONS
  Both port locations are well tolerated. Subfascial placement is associated with more pain during adjustments but there is no difference in port infection or skin erosion rates.
authors.affiliation: John Flynn Private Hospital, Tugun, QLD, Australia. adclough@bigpond.com
authors.forename: Anthony
authors.initials: A
authors.lastname: Clough
authors.forename: Laurent
authors.initials: L
authors.lastname: Layani
authors.forename: Mayenaaz
authors.initials: M
authors.lastname: Sidhu
authors.forename: Lucas
authors.initials: L
authors.lastname: Wheatley
authors.forename: Abha
authors.initials: A
authors.lastname: Shah
mesh_terms: D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
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