Management of gastric fold herniation after laparoscopic adjustable gastric banded plication: a single-center experience

Abstract

BackgroundLaparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure, and little is known about its potential complications. ObjectivesHerein, we report on complications of LAGBP and discuss the clinical features and diagnostic and therapeutic strategies in such situations, with emphasis on gastric fold herniation (GFH). SettingUniversity Hospital. MethodsProspectively collected data of 223 patients who underwent LAGBP for morbid obesity between August 2009 and December 2014 were retrospectively analyzed. Follow-up at 1 year was 75%. ResultsEight patients (3.5%) required readmission due to major complications, including 1 trocar site hernia, 1 band leak, 1 gastric stenosis, and 5 GFHs. GFHs occurred mostly in the first postoperative month (4/5, 80%) and at the fundus (5/5, 100%); 4 GFHs occurred in the initial 70 patients. Seven laparoscopic reoperations were required for managing GFH. The gastric band was removed in 3 patients (of 5; 60%). Two patients developed residual intra-abdominal abscess and were treated successfully by image-guided drainage. In March 2012, we reversed the order of our surgical techniques for the subsequent 153 patients and performed greater curvature plication first, followed by band placement. Only one GFH occurred after this change in surgical order (1/153 versus 4/70; P< .05). ConclusionsHigh clinical suspicion assisted by radiological investigations and early surgical intervention is the key for managing GFH after LAGBP. Though GFH complications were rare, we significantly reduced its occurrence by altering the surgical order in LAGBP to plication followed by banding.