Gastric band slippage: gastric necrosis

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Gastric band slippage: gastric necrosis

Authors

M Vix, J Marescaux

Keywords

gastric band slippage,gastric necrosis

Media type

Surgical video

Duration

03'00''

Publication

2004-12

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E-publication

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1574.htm

Gastric band slippage: gastric necrosis

1. Case presentation 00'14''

The case is that of a female patient who had laparoscopic gastric banding 2 years ago. She has been losing weight steadily since the operation. The patient now presents with a 5-day history of persistent vomiting and progressively worsening epigastric pain. A contrast study was performed and revealed a complete blockage at the level of the gastric band and severe dilatation of the stomach proximal to this.

2. Dissection 00'39''

This expedites the immediate laparoscopic exploration. We can see the catheter of the band now. This is followed in order to identify the exact position of the band itself. Dissection is performed to separate the adhesions, which are formed. We search for the fastening mechanism of the band, which is the most bulky part and therefore identifiable. The dissection is continued and the fastening mechanism comes into view.

3. Band removal 01'18''

The plastic is cut in order to disassemble the band. Following division at this level, the dissection can be continued on the rest of the band in order to separate it from the tissues. This should enable us to extract the band from the retrogastric tunnel. The band is now free. It can be extracted from the abdominal cavity. It is immediately placed in a bag ready for retrieval. Each piece of the band is carefully placed in a bag to ensure that no pieces are left in the abdomen. The bag is now wrested away from the field of dissection to be retrieved at the end of the operation.

4. Laparoscopically assisted percutaneous endoscopy 02'14''

Now we are ready to assess the viability of the proximal gastric pouch in order to determine whether any resection needs to be performed. The serosal appearance suggests that there may be some underlying necrosis. An opening is made at this point so that we can visualize the gastric mucosa endoscopically. Once the gastrotomy is adequate, a purse-string stitch is placed around the edges in order to facilitate the insertion of the balloon trocar necessary for percutaneous endoscopy. The balloon trocar is inserted now and the stomach is pulled up against the abdominal wall and the purse-string tightened around the trocar in order to maintain an airtight seal. The balloon is then inflated. Gas is insufflated into the stomach and an endoscope is inserted through the trocar. We now see the endoscopic view. As evident, the proximal mucosa is necrotic. Therefore, this patient has gastric pouch necrosis. At this point, the gastrotomy was closed and the operation was converted to open surgery, and a proximal partial gastrectomy was performed. The patient made a good postoperative recovery. The patient was restarted on oral nutrition on the 4th postoperative day.