Background: For some patients, especially those with a higher BMI, a non-selective Lap-Band® placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours. Case Reports: Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band® placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow. Conclusion: Obstructive symptoms associated with the Lap-Band® using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band® for the pars flaccida approach could easily prevent this early complication.
Obstructive symptoms associated with the 9.75-cm Lap-Band® in the first 24 hours using the pars flaccida approach / Bernante P.; Pesenti F.F.; Toniato A.; Zangrandi F.; Pomerri F.; Pelizzo M.R.. - In: OBESITY SURGERY. - ISSN 0960-8923. - ELETTRONICO. - 15:3(2005), pp. 357-360. [10.1381/0960892053576541]
Obstructive symptoms associated with the 9.75-cm Lap-Band® in the first 24 hours using the pars flaccida approach
Bernante P.;
2005
Abstract
Background: For some patients, especially those with a higher BMI, a non-selective Lap-Band® placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours. Case Reports: Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band® placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow. Conclusion: Obstructive symptoms associated with the Lap-Band® using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band® for the pars flaccida approach could easily prevent this early complication.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.