title: Management of gastric fold herniation after laparoscopic adjustable gastric banded plication: a single-center experience.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure, and little is known about its potential complications.
  
  
  OBJECTIVE
  Herein, we report on complications of LAGBP and discuss the clinical features and diagnostic and therapeutic strategies in such situations, with emphasis on gastric fold herniation (GFH).
  
  
  METHODS
  University Hospital.
  
  
  METHODS
  Prospectively collected data of 223 patients who underwent LAGBP for morbid obesity between August 2009 and December 2014 were retrospectively analyzed. Follow-up at 1 year was 75%.
  
  
  RESULTS
  Eight patients (3.5%) required readmission due to major complications, including 1 trocar site hernia, 1 band leak, 1 gastric stenosis, and 5 GFHs. GFHs occurred mostly in the first postoperative month (4/5, 80%) and at the fundus (5/5, 100%); 4 GFHs occurred in the initial 70 patients. Seven laparoscopic reoperations were required for managing GFH. The gastric band was removed in 3 patients (of 5; 60%). Two patients developed residual intra-abdominal abscess and were treated successfully by image-guided drainage. In March 2012, we reversed the order of our surgical techniques for the subsequent 153 patients and performed greater curvature plication first, followed by band placement. Only one GFH occurred after this change in surgical order (1/153 versus 4/70; P< .05).
  
  
  CONCLUSIONS
  High clinical suspicion assisted by radiological investigations and early surgical intervention is the key for managing GFH after LAGBP. Though GFH complications were rare, we significantly reduced its occurrence by altering the surgical order in LAGBP to plication followed by banding.
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan; Division of General Surgery, Department of Surgery, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan; Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Dev
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Katakwar
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan; Division of General Surgery, Department of Surgery, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Hsin
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan; Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan; Division of General Surgery, Department of Surgery, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan. Electronic address: bmiscedah@gmail.com.
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
mesh_terms: D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000209:etiology / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Bariatric surgery; Gastric fold herniation; Laparoscopic adjustable gastric banded plication; Laparoscopic adjustable gastric banding; Laparoscopic greater curvature plication