Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases

Abstract 

Background

One of the complications of laparoscopic adjustable gastric banding is intragastric erosion, leading to a revisional procedure to remove the band. Our aim was to present the procedure and results of endoscopic band removal in a 5-year multicenter experience from the Gastro Obeso Center and Universidade de São Paulo, São Paulo, and Universidade Federal de Pernambuco, Recife, Brazil.

Methods

From 2003 to 2008, 82 patients were diagnosed with band erosion. The clinical data concerning the endoscopic procedure were prospectively recorded and retrospectively reviewed.

Results

The average preoperative body mass index was 43.2 kg/m² (range 34–50). At the diagnosis of intragastric erosion, the body mass index was 24–41 kg/m² (average 31.8). The erosion occurred an average of 16.3 months (range 6–36) postoperatively. The symptoms included pain in 25 (31%), port infection in 21 patients (27%), and weight regain in 20 (25%), and 12 patients (15%) were asymptomatic. Endoscopic removal was possible for 78 patients (95%). In 85% of patients, the band was removed in the first session, with an average duration of 55 minutes (range 25–150). Five cases of pneumoperitoneum occurred after the procedure. Of these, 3 were treated conservatively, 1 was treated by laparoscopy, and 1 was treated by abdominal puncture using the Veress needle.

Conclusion

Endoscopic removal of eroded laparoscopic adjustable gastric banding is safe and effective. It can be used as a first choice procedure in clinical practice.

Keywords: Laparoscopic adjustable gastric banding, Postoperative complications, Band erosion, Gastroscopic removal, Band migration, Endoscopic band removal