A modified surgical technique to prevent pouch dilatations after laparoscopic adjustable gastric banding

Background: Laparoscopic adjustable gastric banding is a widely used and effective procedure for the treatment of morbid obesity, but its major complication, the dilatation of the gastric pouch, is reported with a frequency ranging from 1.5 to 26.3%, and often requires removal of the band. With the aim to prevent this complication, we introduced a modified technique in our clinic, over the last 4 years. Methods: From December 1993 to August 2004, 649 morbidly obese patients underwent adjustable gastric banding (AGB), 83 patients in open surgery and 566 patients laparoscopically. The first 323 patients were operated with the perigatric procedure, and 57 patients were operated with the pars flaccida procedure. Since December 2000, 269 patients were operated with a modified technique of the pars flaccida procedure, which consisted in suturing the lesser gastric curvature with one or two stitches to the right crus. Results: In the first group of 323 patients, the most important late complication was the irreversible dilatation of the upper gastric pouch, which occurred in 35 patients (10.8%), and required removal of the band in 30 cases and replacement in 5 cases. In the second group of 57 patients, there were 3 pouch dilatations (5.2%) which required replacement. In the last 269 patients operated with the new technique, since December 2000, only 4 dilatations occurred (1.48%), which required 3 band removals and 1 band replacement. Conclusions: A technical modification of the usual procedure appears to considerably reduce the major complication of adjustable gastric banding, the dilatation of the gastric pouch.