Three-Year Experience of Pouch Dilatation and Slippage Management after Laparoscopic Adjustable Gastric Banding
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. Materials and Methods: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. Results: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. Conclusion: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
Abstract
Purpose: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. Materials and Methods: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. Results: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. Conclusion: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
참고문헌 (29)
- Tolonen P, "11-year experience with laparoscopic adjustable gastric banding for morbid obesity--what happened to the first 123 patients?", Obes Surg, 18, pp.251~255 (2008)
- Himpens J, "Long-term outcomes of laparoscopic adjustable gastric banding", Arch Surg, 146, pp.802~807 (2011)
- Suter M, "A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates", Obes Surg, 16, pp.829~835 (2006)
- Stroh C, "Fourteen-year long-term results after gastric banding", J Obes, 2011, pp.128451~ (2011)
- Kriwanek S, "Band slippage--a potentially life-threatening complication after laparoscopic adjustable gastric banding", Obes Surg, 15, pp.133~136 (2005)
- Hofer M, "Recurrent aspiration pneumonia after laparoscopic adjustable gastric banding", Obes Surg, 17, pp.565~567 (2007)
- Chang Ik Yoon, "Early experience with diagnosis and management of eroded gastric bands", 대한외과학회지, 82(1), pp.18~27 (2012), 대한외과학회
- Seo WJ, "Novel method for port implantation in lap-band surgery--transumbilical subfascial port implantation", J Laparoendosc Adv Surg Tech A, 22, pp.254~258 (2012)
- Fielding GA, "A step-by-step guide to placement of the LAP-BAND adjustable gastric banding system", Am J Surg, 184, pp.26S~30S (2002)
- Ponce J, "Laparoscopic adjustable gastric banding: 1,014 consecutive cases", J Am Coll Surg, 201, pp.529~535 (2005)
- Vertruyen M, "Repositioning the Lap-Band for proximal pouch dilatation", Obes Surg, 13, pp.285~288 (2003)
- Manganiello M, "Management of slipped adjustable gastric bands", Surg Obes Relat Dis, 4, pp.534~538 (2008)
- Moser F, "Pouch enlargement and band slippage: two different entities", Surg Endosc, 20, pp.1021~1029 (2006)
- Sherwinter DA, "Posterior prolapse: an important entity even in the modern age of the pars flaccida approach to lap-band placement", Obes Surg, 16, pp.1312~1317 (2006)
- Egan RJ, "The reporting of gastric band slip and related complications; a review of the literature", Obes Surg, 21, pp.1280~1288 (2011)
- Brown WA, "Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management", Obes Surg, 18, pp.1104~1108 (2008)
- Avsar FM, "Is gastro-gastric fixation suture necessary in laparoscopic adjustable gastric banding? A prospective randomized study", J Laparoendosc Adv Surg Tech A, 21, pp.953~956 (2011)
- Fried M, "Adjustable gastric banding outcomes with and without gastrogastric imbrication sutures: a randomized controlled trial", Surg Obes Relat Dis, 7, pp.23~31 (2011)
- Lazzati A, "fixation during gastric banding necessary? A randomised clinical study", Obes Surg, 21, pp.1859~1863 (2011)
- Keidar A, "Band slippage after laparoscopic adjustable gastric banding: etiology and treatment", Surg Endosc, 19, pp.262~267 (2005)
- O’Brien PE, "Laparoscopic adjustable gastric banding in the treatment of morbid obesity", Arch Surg, 138, pp.376~382 (2003)
- Wiesner W, "Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications", Radiology, 216, pp.389~394 (2000)
- Carucci LR, "Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications", Radiol Clin North Am, 45, pp.261~274 (2007)
- Chevallier JM, "Adjustable gastric banding in a public university hospital: prospective analysis of 400 patients", Obes Surg, 12, pp.93~99 (2002)
- Suter M, "A 3-year experience with laparoscopic gastric banding for obesity", Surg Endosc, 14, pp.532~536 (2000)
- Suter M, "Laparoscopic band repositioning for pouch dilatation", slippage after gastric banding: disappointing results, 2001, pp.11, 507~512
- Foletto M, "Laparoscopic gastric rebanding for slippage with pouch dilation: results on 29 consecutive patients", Obes Surg, 18, pp.1099~1103 (2008)
- Srikanth MS, "Critical extreme anterior slippage (paragastric Richter’s hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation", Obes Surg, 15, pp.207~215 (2005)
- WHO Expert Consultation, "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies", Lancet, 363, pp.157~163 (2004)