Laparoscopic removal of gastric band

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Laparoscopic removal of gastric band

Authors

M Vix, J Marescaux

Media type

Surgical video

Duration

05'00''

Publication

2005-08

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E-publication

WeBSurg.com, Aug 2005;5(08).
URL: http://www.websurg.com/doi-vd01en1712.htm

Laparoscopic removal of gastric band

1. Clinical history 00'03''

This video will illustrate the removal of a gastric band. This is a 28-year-old female patient with a previous placement of a gastric band for morbid obesity 2 years ago. In 2 years’ time, her BMI has decreased from 35 to 28. She presents with severe dysphagia in emergency department and she is hospitalized for dehydration. A full evaluation is commenced. An upper GI radiography is performed. The upper GI shows the esophagogastric junction and distal to this, the band is noted to be out of position with a mechanical stenosis of the distal part of the gastric pouch.

2. Patient positioning 00'40''

With the patient’s symptomatology and the radiographic evidence laparoscopy is performed with the intention of removing the band. The laparoscopy shows the adhesions between the stomach, the band, and the left side of the liver.

3. Liver exposure 01'10''

We begin to expose the band with cutting the adhesions utilizing scissors. Note the 2 retracting trocars laterally, one will be utilized to retract the liver and the other to aid with stabilizing the band.

4. Dissection of the band 01'35''

A total of 5 trocars are used for this procedure, a 10mm for the optic in the peri-umbilical region and four 5mm trocars in the epigastrium flank. We are currently dissecting the anterior fat pad free to allow adequate exposure of the band. Tension is now placed on the band to be able to retract it and allow for the scissors to cut it.

5. Removing the band 02'10''

Once we complete cutting the band we note that it is still attached and additional dissection is done with electrocautery in the remaining adhesions next to the buckle of the band. After these adhesions are taken down with electrocautery, the band is noted to be free. We will place the band aside at this time. With removal of the band we have now eliminated the mechanical process resulting in the patient’s dysphagia. Postoperatively, the patient will have shown to have a complete resolution of the symptoms. The anterior fat pad will now be dissected away to fully evaluate the anterior gastric wall to assure that there is no ischemic process secondary to the band malposition. We use electrocautery to aid in this dissection. Of note additionally, a gastroscopy was performed prior to laparoscopy. No evidence of ischemia was noted on this evaluation however. In this patient, it is imperative to make sure that there is not an ischemic process undergoing as this would be an extremely morbid state. Similarly we now evaluate the posterior wall of the stomach by opening the lesser omentum to make sure that there is not an ischemic process along the posterior wall of the stomach due to the band. Upon confirmation of this, this completes the procedure. The band will be removed through the optical port and the fascia closed at this site as it was the only 10mm port utilized during the procedure. The patient will be re-evaluated in 6 months noting her dietary intake at that time as we have noted often times patients do continue the same dietary habits during the banding process to enable them to continue their dietary intake as they had while the band was in place. However, some patients feel that this conservative method in gastric bypass is indicated.