All strictures are not alike: laparoscopic removal of nonadjustable Silastic bands after banded Roux-en-Y gastric bypass

Abstract

BackgroundThe concept of a nonadjustable Silastic band (NASB) has been used to promote surgically induced weight loss for >30 years. Vertical banded Roux-en-Y gastric bypass is an example. Some patients develop serious, band-related complications requiring treatment. Narrowing at the NASB will lead to refractory nausea, vomiting, regurgitation, and, even, malnutrition, requiring revision of their bariatric operation. We report on the evaluation, diagnosis, and laparoscopic treatment of proximal obstructive symptoms secondary to a NASB. MethodsFrom February 2005 to January 2009, we retrospectively reviewed the preoperative and perioperative data for 6 patients who had presented with proximal obstructive symptoms after undergoing banded Roux-en-Y gastric bypass. ResultsThe mean interval from primary NASB placement to surgery was 58 months (range 25–110). The mean duration of symptoms was 29 months (range 8–70). All patients presented with multiple symptoms, but all had nausea, vomiting, regurgitation, and dysphagia to liquids and solids. The patients had undergone multiple upper endoscopies (mean 4, range 3–6) and dilations (mean 1.3, range 1–2) without relief of their symptoms. All patients underwent successful laparoscopic removal of the NASB. Their mean hospital stay was 1 day (range 0–2). No operative or postoperative complications occurred. The reflux and obstructive symptoms had resolved immediately postoperatively in all patients. ConclusionPatients with a NASB in place can experience proximal obstructive symptoms. Endoscopy is deceptive in judging the stomal size, because the endoscope can be pushed through the band area. Moreover, endoscopic dilation will offer no benefit in most patients with symptomatic banded Roux-en-Y gastric bypass. Laparoscopic removal of the NASB is safe, relieves the symptoms immediately, and can be applied to patients who have undergone both open and laparoscopic Silastic banded bariatric procedures.