title: Evolving pattern of laparoscopic gastric band access port complications.
abstract: Laparoscopic gastric banding (LGB) is the commonest bariatric procedure in Australia. The commonest complication of LGB is access port or tubing (AP/T) problems, requiring revisional surgery. The aim of this study was to document the evolving pattern of AP/T complications. All patients whose LGB procedure (Allergan(TM) Bands) and AP/T revision (Allergan(TM) port revision sets) were performed by one surgeon (1999 to 2008) were included, giving 167 AP/T revisions in 124 patients out of a total 1,928 LGB patients. All patient follow-up details were prospectively recorded and retrospectively analysed. Incidence of LGB AP/T problems was 8.7%. Mean time to first AP/T revision was 2 years. Over the last 4 years of the series, the number of LGB insertions was constant, but the number of AP/T revisions progressively increased. Twenty-seven percent of AP/T revision patients required two or more AP/T revisions. Sixty-two percent of the AP/T complications were leaks. Half the AP complications were flipping of the AP. There was no correlation of AP/T problems with any changes to port design to date. Infection rate for LGB insertion was 0.67%. The incidence of LGB AP/T complications progressively increases with duration after LGB insertion. Occurrence of one AP/T problem appears to select a subgroup more likely to experience further AP/T problems. To date, revisions of port design do not appear to have solved AP/T problems. Recent introduction of a significantly redesigned port may reduce AP/T failures.
authors.affiliation: Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia. chtog79@yahoo.com.sg
authors.forename: Chek Heng
authors.initials: CH
authors.lastname: Tog
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Halliday
authors.forename: Yet
authors.initials: Y
authors.lastname: Khor
authors.forename: Tuck
authors.initials: T
authors.lastname: Yong
authors.forename: Stephen
authors.initials: S
authors.lastname: Wilkinson
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure