Skip to main content
SpringerLink
Log in

Symmetrical Pouch Dilatation After Laparoscopic Adjustable Gastric Banding: Incidence and Management

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) has commonly been complicated by the problem of band slippage or prolapse. Since popularization of the pars flaccida approach and improved anterior fixation, it is our impression that the problem of symmetrical dilatation of the proximal gastric pouch has become more important.

Methods

We have reviewed the results of a series of 425 LAGB all performed by the pars flaccida approach from June 2003 to October 2007 to analyze the incidence and implications of this new pattern.

Results

There were no posterior prolapses, 2 anterior prolapses, and 17 cases of symmetrical pouch dilatation (SPD) (revision rate 4.4%). Teenage patients had a 22% revision rate for SPD. All revisions were completed laparoscopically with no mortality, no significant complications, and a median hospital stay of 1 day. The median weight loss following revisional surgery was not significantly different from the background cohort.

Conclusion

SPD is the most common reason for revision of LAGB in this series. We postulate that SPD is caused by excessive pressure in the proximal gastric pouch. This may be generated either by eating too quickly or too large a volume or excessive tightening of the band. The radial forces in the pouch may ultimately cause pressure on the phrenoesophageal ligament and a secondary hiatal hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40.

    Article  PubMed  Google Scholar 

  2. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135(3):326–51.

    Article  PubMed  Google Scholar 

  3. Allen JW. Laparoscopic gastric band complications. Med Clin North Am. 2007;91(3):485–97, xii.

    Article  PubMed  Google Scholar 

  4. Gagner M, Gentileschi P, de Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.

    Article  PubMed  Google Scholar 

  5. Suter M, Bettschart V, Giusti V, et al. A 3-year experience with laparoscopic gastric banding for obesity. Surg Endosc. 2000;14(6):532–6.

    Article  PubMed  CAS  Google Scholar 

  6. O’Brien PE, Brown WA, Smith A, et al. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg. 1999;86(1):113–8.

    Article  PubMed  CAS  Google Scholar 

  7. Fielding GA, Allen JW. A step-by-step guide to placement of the LAP-BAND adjustable gastric banding system. Am J Surg. 2002;184(6B):26S–30S.

    Article  PubMed  Google Scholar 

  8. O’Brien PE, Dixon JB, Laurie C, Anderson M. A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg. 2005;15(6):820–6.

    Article  PubMed  Google Scholar 

  9. Sherwinter DA, Powers CJ, Geiss A, et al. Posterior prolapse: an important entity even in the modern age of the pars flaccida approach to lap-band placement. Obes Surg. 2006;16(10):1312–7.

    Article  PubMed  Google Scholar 

  10. Elias BB, Staudt JP, Van Vyne EE. The technical approach in banding to avoid pouch dilatation. Obes Surg. 2001;11(3):311–4.

    Article  PubMed  CAS  Google Scholar 

  11. Ren CJ, Horgan S, Ponce J. US experience with the LAP-BAND system. Am J Surg. 2002;184(6B):46S–50S.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Obesity Research and Education, Monash University, Melbourne, Australia

    Wendy A. Brown, Paul R. Burton, Margaret Anderson, Anna Korin, John B. Dixon & Paul E. O’Brien

  2. Monash University Department of Surgery, The Alfred Hospital, Melbourne, Australia

    Wendy A. Brown, Paul R. Burton & Paul E. O’Brien

  3. Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia

    Geoffrey Hebbard

Authors
  1. Wendy A. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul R. Burton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaret Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Korin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John B. Dixon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geoffrey Hebbard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul E. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wendy A. Brown.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brown, W.A., Burton, P.R., Anderson, M. et al. Symmetrical Pouch Dilatation After Laparoscopic Adjustable Gastric Banding: Incidence and Management. OBES SURG 18, 1104–1108 (2008). https://doi.org/10.1007/s11695-008-9485-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-008-9485-z

Keywords

Search

Navigation