Gastric Sleeve Obstruction From Adjustable Gastric Band Capsule

Video Type: CVideo
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Author: David Schwartzberg
Published:
Specialties: Endoscopy, General Surgery
Schools: NYU Langone Medical Center, New York University Langone Medical Center
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Basic Info

The field of metabolic and bariatric surgery has recently switched from laparoscopic gastric banding (LGB) to laparoscopic sleeve gastrectomy (LSG) as the procedure of choice for weight loss surgery. As LGB has been replaced with LSG many patients who had complications with LGB or failed to loose a satisfactory amount of weight with LGB have had a conversation from their band to a sleeve gastrectomy.

Meticulous dissection takes place when removing a band, as the fibrotic scar capsule that surrounds the band must be resected in its entirety to avoid staple firings across fibrotic tissue rather than healthy gastric tissue. In addition to ensuring a healthy staple line by resecting the fibrotic capsule, we present a case where the band capsule was thought to be removed however was incompletely dissected and caused a postoperative strictured proximal stomach with complete PO intolerance. For this reason, we routinely perform intra-operative endoscopy to ensure the lumen of the stomach is patent prior to staple firing to complete the sleeve gastrectomy in band to sleeve patients.

DOI#: http://dx.doi.org/10.17797/19tn2xjdda

Advanced

Procedure

Laparoscopic gastric band converted to a laparoscopic sleeve gastrectomy

Indications

Inadequate weight loss with gastric band, complications of gastric band (slip, erosion, prolapse)

Contraindications

Any contraindication to laparoscopy

Instrumentation

Setup

Reverse Trendelenburg, foley catheter, standard upper gastrointestinal laparoscopic port placement

Preoperative Workup

upper gastrointestinal series, endoscopy

Anatomy and Landmarks

Advantages/Disadvantages

shorter length of stay, less overall pain

Complications/Risks

bleeding, infection, staple line leak, venous thrombosis

Disclosure of Conflicts

none

Acknowledgements

References

Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide. Can J Surg. 2013 Oct; 56(5): 347-352. DOI: https://doi.org/10.1503/cjs.033511

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