[Treatment of intragastric migration of a bariatric gastric ring]

[Intragastric migration of adjustable gastroplasty bands]

BACKGROUND

The incidence of morbid obesity is increasing in France; adjustable gastric banding has become the most common surgical treatment.

PATIENTS

We report seven cases of patients who presented with gastric erosion as a complication of gastric banding; this occurred at a mean interval of 4 years following the initial bariatric procedure.

RESULTS

In six cases, repair was performed laparoscopically; one case required conversion to an open laparotomy approach. There was no mortality but morbidity occurred in 57% of cases: pleural effusion (two) and wound abscess (two).

CONCLUSION

Gastric erosion and migration of adjustable gastric rings can occur at a long interval after laparoscopic gastric banding. Long-term follow-up is necessary in all such patients.

[Reintervention for failed vertical banded gastroplasty: the adjustable lapband offers a useful technique to further restrict a restrictive procedure]

BACKGROUND

Reintervention for failed bariatric procedures is a subject of much debate. Our experience in remediating failed vertical banded gastroplasty (VBG) suggests that the placement of an adjustable lapband may be a useful technique.

PATIENTS AND METHODS

Over a 13-year period, 98 patients with failed VBG underwent remedial placement of an adjustable lapband. Unsatisfactory results of VBG were due to disruption of the staple line in 58% of cases and to outlet enlargement in 37% of patients. Mean BMI was 38 (range: 28-48); BMI was less than 35 in 37% of cases.

RESULTS

Seven postoperative complications (7%) were noted and required the removal of the lapband in five cases. The average loss of excess weight was 52% at 8 years. Twenty-two percent of patients were lost to follow-up.

CONCLUSION

Placement of an adjustable lapband has proved to be a useful remedial approach in the majority of cases and demonstrates that further restriction of a previous restrictive procedure is useful in patients who initially responded well to VBG.