Reduction in Slippage with 11-cm Lap-Band^® and Change of Gastric Banding Technique

Background: Slippage occurs after 2-18% of gastric bandings performed by the perigastric technique (PGT). We investigated the slippage-rate before and after the introduction of the pars flaccida technique (PFT) and the 11-cm Lap-Band^®, and the long-term results of the re-operated patients. Methods: Between Dec 1996 and Feb 2004, 360 patients with a mean BMI of 44 kg/m² were operated. The PGT (n=168) and PFT_9.75 (n=15) groups received the 9.75-cm Lap-Band^®, and the PFT₁₁ group (n=177) received the new 11-cm Lap-Band^®. Follow-up rate was 99%. Results: Slippage occurred in a total of 31 patients from all groups (PGT, n=28, or 17%; PFT_9.75, n=1, or 7%; PFT₁₁, n=2, or 1%). Average yearly re-operation rate for slippage in the first 3 years postoperatively was 3.8%, 2.2% and 0.9%, respectively. Laparoscopic re-banding was necessary for posterior (n=19) or lateral (n=12) slippage. The late postoperative course after re-banding was: uneventful 58%, weight regain 35% and/or esophageal motility disorder 23%, secondary band intolerance 20%, and one persistent posterior slippage. 8 patients (26%) needed biliopancreatic diversion. Conclusion: Since the introduction of the PFT and the 11-cm Lap-Band^®, we observed a significant reduction in slippage rate and no posterior slippage. Re-banding had a less favorable long-term result than did first-procedure banding.