[Intra-gastric penetration of an adjustable gastric band]

Endoscopic removal of partially migrated intragastric bands following surgical gastroplasty: a prospective case series

BACKGROUND

The intragastric migration of a surgically placed adjustable gastric band is believed to occur slowly, over months to years. Band removal procedures necessitate surgical laparotomy, thus increasing the risk of complications.

METHODS

The endoscopic technique for band removal described in this case-series provides a minimally invasive approach.

RESULTS

Fifteen patients referred for endoscopic removal of a partially migrated intragastric band. The partially migrated intragastric bands were all successfully removed in a mean of 1.1 endoscopic sessions. No patient required subsequent surgical intervention, and there were no immediate or delayed adverse events including no infections, bleeding, or perforations.

CONCLUSIONS

Endoscopic removal of partially migrated intragastric bands appears feasible, effective, safe, and is a minimally invasive alternative to repeat surgery.

Experiences of two centers of bariatric surgery in the treatment of intragastrale band migration after gastric banding-the importance of the German multicenter observational study for quality assurance in obesity surgery 2005 and 2006

BACKGROUND

Adjustable silicone gastric banding (ASGB) is an effective treatment in morbid obesity. Band migration is a long-term complication. Causes, clinical symptoms, timing and incidence are investigated in single centres only. In Germany, since January 1st, 2005, practice in bariatric surgery has been investigated in German prospective multicenter trial for quality assurance in obesity surgery.

MATERIALS AND METHODS

All patients underwent ASGB in two centres of bariatric surgery in Germany were prospectively registered using a computer-based data form. Patients with band migration were retrospectively evaluated, in particular, causes and characteristics of its management. The results were correlated with data obtained from the German prospective multicentre trial.

RESULTS

In total, 493 patients were enrolled in the study from February 1995 to February 2007. The follow-up rate was 79.9% (mean follow-up time period, 78.7 months; range, 2-148 months). Fifteen patients (3.0%) developed migration. In 14 cases, migration occurred within the range of 30-86 months after implantation. In one case, migration occurred 10 months after repositioning of the band. In the German multicentre trial, 629 patients underwent surgery during 2005 and 827 patients in 2006. In both periods, 74.4% of the patients were female and 25.6% male. The most frequently performed operation was ASGB (46.8%) followed by Roux-en-Y gastric bypass (38.5%).

CONCLUSION

Band migration requires band removal. Different symptoms and complications influence the kind of band removal. Multicentre data were evident in the case of high long-term complication rate after ASGB. Data of the German multicentre trial show the trend from restrictive bariatric procedures to malabsorptive approach.

Komplikationen nach steuerbarem Gastric Banding

BACKGROUND

Adjustable gastric banding is a popular bariatric operation in Europe. About 1500 patients per year undergo a such procedures in Germany. Clinical data on the rate of long-term complications such as pouch dilatation, slippage, and band migration are available in only a few long-term studies with small numbers of patients. Meta-analyses report on comordities and reduction in weight. The rate and management of long-term complications were examined at this inquiry.

METHODS

Ninety hospitals were asked about rates of band implantation, follow-up, and complications. Thirty-eight hospitals (42.2%) participated in the study. The management of complications including slippage, pouch dilatation, and band migration was analyzed.

RESULTS

At 35 hospitals, 4138 patients underwent gastric banding procedures in 25 hospitals over more than 5 years. The mean follow-up rate is presently 85.3%. Long-term complications were described in 8.6% of the patients. Pouch dilatation occurred in 5.0%, slippage in 2.6%, and band migration in 1.0%.

CONCLUSIONS

Laparoscopic adjustable gastric banding can effectively achieve weight loss. However, band-related and functional complications influence late outcome. The rate of long-term complications was equivalent to that already in the literature.

[Band migration. A late complication of gastric banding]

BACKGROUND

Adjustable silicone gastric banding is an effective and safe treatment for morbid obesity. Migration of the band through the stomach wall is a long-term complication. The causes, clinical symptoms, timing, and incidence of band migration have not yet been investigated.

METHODS

We report our experience over 9 years. Between February 1995 and February 2004, we performed adjustable silicone gastric banding in 161 patients, with follow-up of about 90.5% of cases. Mean follow-up time was 60.4 months. Cases of erosion were studied retrospectively.

RESULTS

Eight patients (4.9%) developed band migration. In seven, the migration occurred between 30 and 86 months after band implantation. In one case, the migration occurred 10 months after laparoscopic repositioning of the band to avoid pouch dilatation. In all cases, the bands were removed.

CONCLUSION

Band migration is a late complication after gastric banding that requires band removal. Various symptoms and complications of band migration influence the kind of band removal. The causes of band migration and its treatment are discussed.

Gastric Banding: chirurgisch-technische Aspekte

Morbid obesity (body mass index >40 kg/m(2)) is a risk factor for cardiovascular, pulmonary, metabolic, neoplastic, and psychologic sequelae. Laparoscopic adjustable gastric banding (LAGB) has been established for more than 10 years as a good, safe therapy for morbid obesity if strict operational indications are observed and there is multidisciplinary, long-term follow-up. The technical aspects of LAGB are important for its long-term success. The pars flaccida technique is standard and leads to fewer complications. The bands should be placed above the bursa omentalis. Different types of bands are available. Band fixation by suturing with nonabsorbable stitches prevents slippage. The port system also must be fixated by nonabsorbable sutures.