Technique for nonfascial fixation of the laparoscopic adjustable gastric band access port

Abstract 

Background

Access port complications occur in 10–20% of patients undergoing laparoscopic adjustable gastric banding (LAGB). These have included infection, leakage, difficult access, erosion, pain, and poor cosmetic results requiring revision. Additionally, traditional fascial fixation techniques require longer operative times and fluoroscopic or ultrasound localization, increasing the time, expense, and discomfort associated with LAGB. We report a technique of nonfascial fixation of the LAGB access port with minimal complications.

Methods

From August 2001 to August 2007, 1027 consecutive patients underwent LAGB. Of the 1027 patients, 1008 (97%) were available for follow-up for >1 year. The access port was placed in a subcutaneous pocket created 2 cm deep to the skin anterior to the sutures. The group was analyzed for complications requiring revision, operative placement time, ease of access, and the need for radiographic localization of the port.

Results

A total of 0 (0%) early postoperative infections and 6 (.6%) late postoperative infections developed. Other complications requiring revision were follows: skin erosions in 2 (.2%), poor cosmetic results in 2 (.2%), malposition in 2 (.2%), and leakage from access trauma in 3 (.3%). Overall, 15 access port complications (1.5%) developed. The port placement time averaged 5 minutes, and no patient required ultrasound or fluoroscopic guidance for access.

Conclusions

Nonfascial fixation of the LAGB access port, using a technique familiar to most general surgeons, was associated with fewer complications than traditional fascial fixation. Additionally, the operative time, ease of access, and patient comfort and expense were positively affected by this technique.

Keywords: Laparoscopic adjustable gastric banding, Access port, Complications, Port inversions, Port migration, Anterior rectus sheath, Port fixation