Band erosion : our experience with gastroscopic band removal

Background: Band erosion is an unusual but major long-term complication of gastric banding; its frequency ranges from 0.5 to 3.8% and always requires removal of the band. Different laparoscopic, laparotomic or endoscopic methods are currently used to remove the band. Methods: 673 morbidly obese patients underwent adjustable gastric banding from February 1998 to March 2007. Band erosion occurred in 3 patients, and 6 more patients were referred to our Center from other hospitals. To remove the band, in 7 out of 9 patients we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (A.M.I. Agency for Medical Innovation GmbH, Götzis, Austria). Results: The gastric band cutter was able to cut successfully the band in all cases except one, where a twisting of the cutting wire required conversion to laparoscopy. In another case, the band, after being cut, was blocked in the stomach and required laparotomic removal. In 2 patients we had to remove surgically the band, in one case for port-site infection associated with a subphrenic abscess, and in the other case for acute pancreatitis, cholelithiasis and choledocholithiasis, associated with complete band migration in jejunum. Conclusion.The Gastric Band Cutter proved successful in cutting the band in all cases, even if not all bands could be removed gastroscopically. It seems to be the procedure of choice in the treatment of band erosion. It is advisable to do it in the operating room for the possible complications of the procedure.