Band slippage after laparoscopic adjustable gastric banding: Etiology and treatment

• Published in: Surgical endoscopy Vol. 19; no. 2; pp. 262 - 267
• Main Authors: KEIDAR, A, SZOLD, A, CARMON, E, BLANC, A, ABU-ABEID, S
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01-02-2005; Springer Nature B.V
• Subjects: Abdomen; Adult; Biological and medical sciences; Body mass index; Digestive system. Abdomen; Endoscopy; Gastrointestinal surgery; Gastroplasty - adverse effects; Gastroplasty - methods; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Medical sciences; Metabolic diseases; Obesity; Patients; Pneumonia; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Reoperation; Stomach; Weight control; Tel Aviv Israel; Israel; Stomach; Obesity; Nutrition disorder; Band repositioning; Laparoscopy; Treatment; Dilatation; Etiology; Band slippage; Endoscopy; Nutritional status; Laparoscopic gastric banding; Pouch dilatation
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-003-8261-3

Laparoscopic adjustable gastric banding is a safe and effective procedure for the management of morbid obesity. However, band slippage is a common complication with variable presentation that can be rectified by a second laparoscopic procedure.
We studied case series of 125 consecutive patients who suffered from band slippage between November 1996 and May 2001 from a group of 1,480 laparoscopic adjustable gastric banding procedures performed during this time. The decision of whether to remove or replace/reposition the band was made prior to the operation, although the specific method used when replacement or repositioning was deemed suitable was determined by the operative findings. A laparoscopic approach was used in all but three patients.
A total of 125 patients (8.4%) suffered band slippage (posterior slippage, 82.4%; anterior slippage, 17.6%). In 70 patients (56%), the band was removed, whereas in 55 patients (44%) it was repositioned or replaced immediately. Of these 55 patients, six underwent later removal, five due to recurrent slippage and one due to erosion. Fourteen patients suffered complications, including gastric perforation (n = 8), intraoperative bleeding (n = 1), postoperative fever (n = 3), aspiration pneumonia (n = 1), upper gastrointestinal bleeding (n = 1), and pulmonary embolism (n = 1).
Band slippage is not a rare complication after laparoscopic adjustable gastric banding. The decision to remove or replace the band or convert to another bariatric procedure should be made preoperatively, taking both patient preference and etiology into consideration. Short-term results indicate that band salvage is successful when the patient population is chosen correctly.