Radiological Assessment of Complications After Laparoscopic Suprabursal Adjustable Gastric Banding for Morbid Obesity

The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions > 10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss