title: Utility of routine barium studies after adjustments of laparoscopically inserted gastric bands.
abstract: OBJECTIVE
  The purposes of this study were to assess the utility of barium studies after adjustments of laparoscopically inserted gastric bands and to identify a threshold stomal diameter for predicting which bands should be loosened because of excessive tightening.
  
  
  METHODS
  A total of 246 patients with laparoscopically inserted adjustable gastric bands underwent 668 routine band adjustments and barium studies after each adjustment. Forty-one barium studies of 30 patients with tight bands necessitating readjustment were compared with barium studies of 41 patients acting as controls. Barium studies of nine patients with obstructive symptoms before adjustment were reviewed to correlate stomal diameter with symptoms. The data were analyzed for a threshold stomal diameter below which obstructive symptoms were likely to develop.
  
  
  RESULTS
  Mean stomal diameters were 2.9 mm for the group with tight bands after routine adjustment, 9.5 mm for the control group, and 5.1 mm for the group with obstructive symptoms. Thirty-nine of the 41 studies of tight bands after routine adjustment showed stomal diameters less than 6 mm. Seven of nine patients with obstructive symptoms and none of the 41 control patients had stomal diameters measuring less than 6 mm. Conversely, 40 of 41 control patients and two of nine patients with obstructive symptoms had stomal diameters greater than 6 mm. In none of the 41 cases in which the band was tight after routine adjustment was the stomal diameter greater than 6 mm. Thus, 6 mm was the threshold stomal diameter below which bands should be loosened.
  
  
  CONCLUSIONS
  A stomal diameter of less than 6 mm after routine adjustment of a laparoscopically inserted gastric band can cause obstructive symptoms, so the band should be loosened in these patients. In contrast, a stomal diameter greater than 7 mm is unlikely to cause obstructive symptoms, so band loosening usually is not required.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Swenson
authors.forename: Marc S
authors.initials: MS
authors.lastname: Levine
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Rubesin
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.forename: Kristoffel
authors.initials: K
authors.lastname: Dumon
mesh_terms: D000328:Adult; D001466:Barium Sulfate; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D015391:Gastroplasty / Q000295:instrumentation*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate