Obesity 01

Abstract

To assess the role and workload of radiology in the postoperative assessment of patients following adjustable laparoscopic gastric band (Lap-Band) insertion. The radiological assessment of band tightness, the technique of band adjustment and the detection of complications are presented. The study population included 32 patients who had undergone Lap-Band insertion over a 4-year period. Postoperative assessment involved monitoring the patients' symptoms and weight loss by serial measurement and calculation of body mass index (BMI). All radiological interventions were documented, including contrast swallows and fluoroscopically controlled adjustments by needle access to the subcutaneous port connected to the Lap-Band device. All needle adjustments were performed using bi-plane fluoroscopy and monitored by contrast swallows. The number and nature of any radiologically detected complications were also recorded. A total of 163 radiological procedures were required in 32 patients. These included 126 needle adjustments (either tightening (injection) or loosening (aspiration) of the band) and 37 contrast swallows, where there was an apparent discrepancy between the patient's symptoms and serial weight loss assessment. Complications included gastric band leakage and erosion into the stomach lumen (three), leakage from the port and connections (two), shifting of the port (five) and rotation of the gastric band (six). Adjustable gastric band insertion is not free of complications and creates a significant and challenging postoperative workload for radiology. Particular difficulty relates to assessment of band tightness, and radiological expertise is required in needle adjustment of the band and detection of complications.