Gastric band slippage: laparoscopic removal of the band

WebSurg is a free virtual surgical university, accessible worldwide through the Internet. Our goal is to provide surgeons, scientific societies and the medical industry with the first online continuing medical education in laparoscopic surgery and information on the latest developments in laparoscopic surgery, including NOTES and robotics.

Create account

Browse the WORLD

Virtual University

Google translate

Summary
Chapters
Your comments
Ask the Experts

You need to log in to watch this media!

Click here to log in.

Gastric band slippage: laparoscopic removal of the band

Authors

M Vix, M Simone, J Marescaux

Keywords

gastric band slippage,laparoscopic removal,band

Media type

Surgical video

Duration

04'00''

Publication

2004-12

Popular

Favorites

Favorites Media

Audio

Subtitles

E-publication

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1563.htm

Gastric band slippage: laparoscopic removal of the band

1. Case presentation 00'08''

This video will demonstrate laparoscopic removal of a slipped gastric band. The case is that of a female patient who had laparoscopic gastric banding 3 years ago. She presented as an emergency with a short history of persistent vomiting. A soluble contrast revealed the blockage at the level of gastric band and gastric distension proximal to this with minimal contrast entering the distal stomach. During the contrast study, the band was deflated in order to assess the passage of contrast. However, this did not have any effect. A decision was then made to laparoscopically explore the patient and remove the gastric band.

2. Dissection 00'44''

Here we see the catheter of the band. This is followed and the surrounding adherences are gently dissected. The catheter acts as a guide to the body of the band. It is now necessary to identify the fasting mechanism, which is the most bulky part of the band and is therefore easily identified. This part of the band is also surrounded by adhesions. This needs to be separated in order to make an adequate assessment. The dissection is continued in order to evaluate the orientation of the band and stomach. It is evident that the proximal pouch is developed at some distance from the cardia, and therefore there has been a significant slippage of the band. More adherences to the band are divided. The band has slipped to cause gastric obstruction despite the presence of these adhesions. The anatomy has been distorted due to the slippage of the band, and it is not straightforward to understand the exact orientation of the structures.

3. Band removal 02'06''

Here is the fasting mechanism, which needs to be divided in order to release the band. The band can then be extracted from the retrogastric tunnel. The parts of the band are then placed in a bag ready for retrieval. It is important not to leave any parts in the abdominal cavity at this point. Part of the catheter is left outside the bag so that it can be easily manipulated. Now to the inspection of the stomach and the proximal pouch.

4. End of dissection 03'18''

The stomach is manipulated gently and examined. This adhesion seems to be constricting part of the stomach, and therefore may hinder transit through the stomach. It is therefore divided. Some minimal dissection of the proximal part is performed. There seems to be no other constricting adhesion so the dissection is limited to this extent. It is likely that this patient will have further morbid obesity surgery, and therefore there is no point in performing a complete adhesiolysis, especially if they do not seem to be affecting gastric function mechanically. The wall of the pouch looks healthy and well-vascularized. The following day, a contrast study was performed, which excluded a leak. Two months later, a further contrast study revealed normal gastric emptying.