Proximal pouch dilatation what is

The median time interval between primary band surgery and diagnosis of pouch dilatation was Conservative management was initially attempted for all patients, except for two cases of posterior slippage cases 12 and 14 that were corrected by immediate band replacement. All four patients cases with CP showed a good response to conservative management. After a median follow-up period of three months range, months , no recurrence of clinic-radiologic signs and symptoms was observed.

However, two patients cases 2 and 4 experienced a slight increase in body weight during the follow-up period. Conservative management was also administered to seven patients with eccentric pouch dilatation with anterior slippage EPA Three EPA1 patients cases showed a positive response to conservative management without operative intervention. Although no recurrence of clinico-radiologic signs and symptoms were observed in these patients, band adjustment with proper saline volume was not possible, and they experienced regain of weight during the follow-up period.

These two patients did not respond to initial conservative management. Severe night time reflux and postprandial epigastric discomfort were the primary reasons for revisions; the other two patients cases 9 and 11 recovered well after conservative management without discomfort. All three EPP patients cases underwent reoperation.

Evidence of lesser sac penetration with redundant posterior fundus was observed during revision in two patients cases 12 and Comparison of pre- and post-intervention data of each group conservative treatment group vs.

In our practice, we used the gastric plication technique below the band in 27 patients Fig. Among 27 patients, only one patient was diagnosed as having concentric pouch dilatation, and there was no single episode of eccentric pouch dilatation. Their median follow-up period was 13 months range, months. Surgery Group. Pouch enlargement and band slippage have been reported as the most common complications after adjustable gastric band placement.

However, we still observed three cases of posterior slippage during our study period. Two patients were within the first ten patients in our practice, and, band placement was not adequate in one patient due to a scar from a previous operation. In our study, the complications were divided into concentric pouch without band slippage 3. Technical problems associated with anterior slippage include rupture of stitches, and sutures that include only perigastric fat, which will become loosened with the passage of time.

For gastrogastric sutures, there are several randomized controlled trials showing conflicting results. In all patients with CP from our study, pouch size was normalized immediately after unfill. If diagnosed early, this type of pouch dilatation may be resolved with deflation of the band. Moser, et al. Eccentric pouch dilatation on UGI barium swallow study, which is most often a late complication following LAGB, is caused by slippage of the band, 23 and is associated with a more serious pouch abnormality associated with band dislocation.

In our study, EPA1 patients showed early band slippage. Radiologically, the angle of the band was normal. However, the configuration showed a somewhat "ring like" pattern rather than a normal slit like shape. Over-tightening of the band with frequent vomiting was the most probable cause for all three patients. In order to prevent this complication, early or rapid band adjustment should be avoided. Because the gastric wall inside the band gastric herniation already exists, even a small addition of saline in the band can cause outlet obstruction.

We recommend a very small and gradual band adjustment under fluoroscopic guidance in these patients. Patients in the EPA2 group showed a more horizontal band angle and a more eccentric pouch. Usually, this type of pouch is a consequence of the chronic process, which is found later, compared to EPA1.

The two patients in our study already achieved their ideal body weight. However, one of these patients underwent band replacement for resistance of severe night time reflux to conservative management. Patients in the EPA3 group presented with acute and more severe symptoms. This type of pouch is usually associated with full-blown band dislocation. For initial management, immediate total unfilling of the band was always preferred.

If symptoms persist, and the pouch is not normalized radiologically, revision should be performed. Various rates of success, from Use of the ultrasonic shear device was very useful to minimize bleeding. We also used anterior and posterior plications in order to stabilize the band during band replacement. Due to extensive adhesion around the pouch, we have not performed simpler gastric reduction as a revision option for management of a slipped band.

Keidar, et al. Manganiello, et al. In general, rupture of a gastrogastric suture can result in anterior slippage of the band. In addition, potential space within the band resulting from reduced perigastric fat due to weight loss may cause slippage.

Srikanth, et al. From the beginning of our practice, we have anecdotally performed anterior plication beneath the band during performance of primary banding surgery with the hope of further stabilizing the band to prevent slippage and pouch dilatation. A total of 27 patients underwent this plication procedure during the study period. With the exception of one patient with a concentric pouch, these patients have not shown eccentric pouch formation.

In fact, the portion of the fundus redundant below the band caused the partial fundal prolapsed, thus causing anterolateral band slippage. For some patients, the redundant portion is in the anterior gastric wall, yet for others, the redundant portion is in the posterolateral gastric wall. Band fixation with anterolateral gastro-gastric plication stitches therefore cannot prevent band slippage and pouch dilatation for all the banded patients.

In summary, pouch dilatation with or without slippage is a long term complication in LAGB patients; the percentage observed in our three-year study was Except for posterior slippage, these complications show an association with postoperative management, such as over tightening of the band or poor compliance among patients. Gradual band adjustment with strict follow-up and continued dietary consultation will prevent or minimize occurrence of these complications.

From a technical point of view with consideration of accurate pars flaccida techniques, accurate seromuscular bites are very important because inaccurate gastrogastric fixation can be loosened with time stitch burst , and eventually make the portion of the fundus redundant below the band.

Removal of the fat pad on the cardia with coagulation greatly facilitates the accurate seromuscular bites. In addition, adequate wrapping also stabilizes the gastric band and minimizes the fundal prolapse, thus avoiding slippage. In the latter case, band revision should be performed usually within weeks to prevent further catastrophes such as dehydration, gastric wall ischemia, and peritonitis. However, frequently, patients regain their body weight with their loosened band.

In that case, we perform an elective surgery for band revision. The proper timing of this elective surgery should be discussed with the patient. Band replacement into the new retrogastric tunnel was effective as a revision option in those who failed to respond to conservative management.

The authors have no financial conflicts of interest. National Center for Biotechnology Information , U. Journal List Yonsei Med J v. Yonsei Med J. Published online Nov Find articles by Woon Ki Lee. Find articles by Seong Min Kim. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Dr. Seong Min Kim.

Tel: , Fax: , moc. This article has been cited by other articles in PMC. Abstract Purpose Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding LAGB. Materials and Methods The pars flaccida technique with anterior fixation of the fundus was routinely used. Keywords: Pouch dilatation, band slippage, laparoscopic adjustable gastric band.

Open in a separate window. CP, concentric pouch dilatation; EWL, excess weight loss. Footnotes The authors have no financial conflicts of interest.

References 1. Obes Surg. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg. A year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Fourteen-year long-term results after gastric banding.

J Obes. Band slippage--a potentially life-threatening complication after laparoscopic adjustable gastric banding. Recurrent aspiration pneumonia after laparoscopic adjustable gastric banding. Early experience with diagnosis and management of eroded gastric bands. J Korean Surg Soc.

Novel method for port implantation in lap-band surgery--transumbilical subfascial port implantation. Am J Surg. Laparoscopic adjustable gastric banding: 1, consecutive cases. J Am Coll Surg. Type-III prolapse following gastric lap band Proximal gastric pouch enlargement Pouch enlargement - following gastric lap band Pouch dilatation - following gastric lap band.

URL of Article. See also gastric lap bands. Three-year experience of pouch dilatation and slippage management after laparoscopic adjustable gastric banding. Sushilkumar K. Sonavane, Christine O. Menias, Kartikeya P. Kantawala, Alampady K. Shanbhogue, Srinivasa R. Prasad, John C. Eagon, Kumaresan Sandrasegaran. Complications associated with adjustable gastric banding for morbid obesity: a surgeon's guides.

Journal canadien de chirurgie. Pouch enlargement and band slippage: two different entities. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Promoted articles advertising. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.

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