Abstract
Introduction:
Intragastric migration is a severe late complication of the gastric band. Its incidence has been reported to be between 0.5% and 11%. 1,2 The most common symptoms are weight gain, recurrent port infection, vomiting, and abdominal pain. The procedure of choice for the removal of gastric band is endoscopy, whereas surgical treatment is reserved for cases in which endoscopy fails. 3 This video presents an innovative procedure of removal of a migrated band through a laparoscopic transgastric approach. 4,5
Methods:
A 77-year-old female underwent a laparoscopic adjustable gastric band in 2013. Her body mass index before surgery was 39 kg/m2. Two years after operation, and because of multiple port infections, the port was removed at another institution in 2014. However, the intra-abdominal portion of the band was left intact for unknown reasons. For the past year, the patient suffered from nausea and vomiting. A barium swallow showed an emptying defect in the esophagogastric junction, which was consistent with possible band erosion. An upper endoscopy showed an erosion of the band into the gastric lumen. The patient was brought to the operation room, and under general anesthesia a new upper endoscopy was performed. After several attempts to remove the gastric band failed, a transgastric laparoscopic removal was performed. After obtaining a pneumoperitoneum, a 12-mm balloon trocar was introduced into the gastric body. A 10-mm endoscope was introduced into the stomach and another 5-mm transgastric balloon trocar was inserted into the stomach along the lesser curvature. The band was then divided with scissors. Finally, the band was removed through one of the gastrotomies and the gastric wall was sutured with Ethibond 2/0.
Results:
The operative time was 60 minutes and the postoperative course was uneventful. The patient was discharged within 3 days. With a follow-up of 6 months, the patient was completely asymptomatic with a good oral intake.
Conclusion:
Although the procedure of choice for the removal of an eroded gastric band is endoscopy, when this is not feasible, removal of the band through a transgastric laparoscopic approach appears to be as a possible alternative.
No competing financial interests exist
.
Runtime of video: 6 mins 30 secs
Get full access to this article
View all access options for this article.