Laparoscopic Removal of Eroded Non-Adjustable Gastric Band and Conversion to Roux-en-Y Gastric Bypass
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MULTIMEDIA ARTICLE
Laparoscopic Removal of Eroded Non-Adjustable Gastric Band and Conversion to Roux-en-Y Gastric Bypass Agustin Duro 1 & Virginia M. Cano Busnelli 1 & Fernando G. Wright 1 & Axel F. Beskow 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This video shows the case of a 64-year-old morbidly obese woman, with a non-adjustable gastric band, who consulted for weight regain and gastroesophageal reflux disease (GERD) symptoms and was converted to Roux-en-Y gastric bypass (RYGB). The operative technique included extensive lysis of adhesions, complete band dissection, partial gastrectomy of the fundus and body due to band erosion and conversion to RYGB. Keywords Bariatric surgery . Gastric band . Non-adjustable gastric band . Gastric bypass . Roux-en-Y gastric bypass . Revisional bariatric surgery . Gastric band erosion
Introduction
Methods
Non-adjustable gastric banding, first introduced in the early 1980s, involved the placement of a silicone ring around the upper part of the stomach to restrict food intake and achieve weight loss [1]. Despite initial promising results, complications and weight regain appeared in long-term follow-up, necessitating reoperation for band correction or removal, and conversion to another bariatric procedure [2, 3].
This video shows a 64-year-old woman with a BMI of 40 kg/m2 and a history of hypertension, hypothyroidism, and asthma, with a non-adjustable gastric band placed in the year 2000 in another hospital, who consulted for weight regain and gastroesophageal reflux disease (GERD) symptoms. A CT scan and a barium swallow revealed a dilated pouch and the band constricting the middle part of the gastric body. Esophagogastroduodenoscopy did not show band penetration.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04631-z) contains supplementary material, which is available to authorized users. * Agustin Duro [email protected] Virginia M. Cano Busnelli [email protected] Fernando G. Wright [email protected] Axel F. Beskow [email protected] 1
Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
Results Operative technique included extensive lysis of adhesions, complete band dissection until a segment was found eroded into the gastric wall, partial gastrectomy, and conversion to Roux-en-Y gastric bypass (RYGB). An antecolic, hand-sewn gastrojejunostomy and a stapled jejunojejunostomy were created. Petersen’s space was left open, and mesenteric defect was closed using non-absorbable sutures. She had no postoperative complications. At 12 months, she has lost 78.54% of her excess body weight and remains asymptomatic for GERD.
OBES SURG
Conclusion Like other revisional procedures, conversion from a nonadjustable gastric band to RYGB can be technically demanding, with increased morbidity, especially in cases when an erosion is present. In expe
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