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Reducing Band Slippage in Laparoscopic Adjustable Gastric Banding: The Mesh Plication Pars Flaccida Technique

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Abstract

Background

Band slippage is a significant complication of laparoscopic adjustable gastric band (LAGB) surgery for the treatment of morbid obesity. This involves prolapse of part of the stomach, with varying degrees of gastric obstruction. The original perigastric technique (PGT) was associated with slippage rates of up to 25%. The pars flaccida technique (PFT) is the more commonly used technique today, reducing slippage rates to as low as 1.4%. We report a technique not previously described, the modified PFT with the use of mesh, and compare slippage rates between these three techniques for band placement.

Methods

A prospectively entered, retrospective review of 1,446 consecutive patients undergoing LAGB by a single surgeon was undertaken. Patients were divided into five consecutive groups: PGT learning curve (PGTLC) (n = 68), PGT (n = 19), mesh PFT (MPFT) (n = 415), mesh plication PFT (MPPFT) (n = 131), and MPPFT with inadequate follow-up (n = 813). Patient characteristics, band slippage, and other complication rates were compared between groups.

Results

The slippage rates for each group were: PGTLC (10%), PGT (5%), MPFT (0.8%), and MPPFT (0%). This demonstrated a statistically significant difference between the slippage rates for each group (p < 0.001). Combining the MPFT and MPPFT groups, there was a statistically significant difference in band slippage compared to the PGT group (p < 0.001).

Conclusion

While the MPFT is associated with low band slippage rates, the MPPFT results in further reductions in band slippage. The routine use of this modification to the MPFT is safe and may reduce operative morbidity. A randomized comparison of these techniques is warranted.

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Authors and Affiliations

  1. Department of Surgery, Royal Hobart Hospital, Tasmania, Australia

    Chantel Mary Thornton, Warren Matthew Rozen, Deborah So, Elan Daniel Kaplan & Stephen Wilkinson

Authors
  1. Chantel Mary Thornton
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  2. Warren Matthew Rozen
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  3. Deborah So
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  4. Elan Daniel Kaplan
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  5. Stephen Wilkinson
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Correspondence to Chantel Mary Thornton.

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The content of this article has not been submitted or published elsewhere.

There was no source of funding for the article.

The authors declare that there is no source of financial or other support, or any financial or professional relationships that may pose a competing interest.

The manuscript has been seen and approved by all authors.

The cost of color figures will be met by the authors.

C.M. Thornton and W. M. Rozen are equal first authors.

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Thornton, C.M., Rozen, W.M., So, D. et al. Reducing Band Slippage in Laparoscopic Adjustable Gastric Banding: The Mesh Plication Pars Flaccida Technique. OBES SURG 19, 1702–1706 (2009). https://doi.org/10.1007/s11695-008-9672-y

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