Port Site Infection Research Articles

Laparoscopic port site complications: a study in a tertiary care centre

Background: Minimally invasive surgeries such as laparoscopic surgeries have become the order of the day for many surgical diseases. Major complications are access related such as major vascular injury or inadvertent bowel injuries, which life is threatening, while other complications such as port site infections may occur which would need proper treatment. The main aim of this study was to assess the port site infection and its management. Methods: 328 patients who underwent laparoscopic surgeries were included in the study and demographic details were noted for all the patients. All of them were given prophylactic antibiotics before the surgery and the surgeries were performed under general anesthesia. Results: 6.4% patients had port site infections among the patients, of which 16 were females 7% and 5.1% were males. The most common site of infection was umbilical with 52.4% cases, followed by epigastric with 38.1% cases. Conclusions: Laparoscopy offers advantage of rapid postop recovery. It is recommended to follow proper technique of sterilization of laparoscopic instruments to prevent PSI.

A prospective study of different complications following laparoscopic cholecystectomy in a tertiary care hospital in Eastern India

Background: Laparoscopic approach for cholecystectomy has already become the standard of care for the management of symptomatic and (in selected cases) asymptomatic cholelithiasis. Despite proven advantages laparoscopic cholecystectomy (LC) is known to be associated with certain complications. Methods: This prospective study was undertaken to document the incidences of such complications and to compare them to those in already published data. A total of 750 cases of LC performed in the department of general surgery at IPGME and R and SSKM hospital, Kolkata were observed for a minimum period of 8 weeks following surgery. The complications were noted and their incidences calculated using simple statistical tools. These were then compared with those in already published data. Results: A total of 493 complications occurred in 483 patients (64.4%). The most common complication was port-site infection (PSI) occurring in 476 patients (63.5%). The other complications included bleeding (1.2%), bowel injury (0.7%) and bile duct injury (0.4%). Mortality occurred in 3 cases (0.4%). Conversions to open cholecystectomy (OC) due to inability to proceed in a timely manner because of difficult exposure or unclear anatomy were not considered as complications rather as an inevitable extension of the primary approach in some difficult scenarios. Conclusions: At the end of our study period we could conclude that the incidences of specific complications in our study are less than those reported from different centres across the globe except for PSI. The alarmingly high incidence of PSI noted is a matter for introspection. A detailed study needs to be undertaken so that appropriate measures may be taken to prevent this scourge.

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology

To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P < .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety.

A5050 - Difficult Removal of an Eroded Gastric Band: An Unconventional Approach to Minimize Tissue Damage

Laparoscopic adjustable gastric banding (LAGB) is a commonly performed weight-loss procedure and has a published long-term complication rate of 16%; 1-3% of these are related to erosion of the band1. The most common manifestations of band erosion are loss of restriction and port site infection and abscess. Gastric band erosion is often associated with inflammation of the surrounding tissues, which can significantly increase the difficulty of surgical or endoscopic removal of the band. We present a case of eroded gastric band complicated by associated port-site abscess and impenetrable adhesions, necessitating a novel surgical approach for safe removal of the band. A 50-year-old female underwent LAGB and had a subsequent 80-pound weight loss over the next 1.5 years. She presented two years after band placement with fever, epigastric pain, and swelling around her access port. She underwent an esophagogastroscopy demonstrating approximately 50% of the band visible in the stomach lumen. She was found to have a large abscess at the port site with marked abdominal tenderness, leukocytosis, and tachycardia. Therefore, we undertook urgent removal of the gastric band.

Laparoscopy in Neonates in Bangladesh: Technical Challenges and Experience in Chittagong

Introduction: Pediatric Minimally Invasive Surgery is a relatively newer concept in Bangladesh and started about 8 years ago. It took some time to gather sufficient expertise to start in the neonates. However, due to resource constraints we are to practice with conventional equipments and still performing soLaparoscopy in Neonates in Bangladeshme advanced procedures. We are one of the pioneers in neonatal laparoscopy in Bangladesh and this article will review the common procedures that we perform.Materials and methods: From 7, October 2005 to 30, June 2011, 1953 cases underwent laparoscopic/thoracoscopic procedures in our department of which 117 were neonates. We have used conventional 5 mm 30 cm instruments including 5 mm 30º telescope. First trocar was introduced by open method and CO2 was pressure was kept below 8 mmHg. Age, sex, indications, operative procedures, complications and outcomes are evaluated retrospectively.Results: Ages ranged from 3 days to 30days with males predominant (1: 0.56). Laparoscopy-assisted pullthrough for Hirschsprung’s disease was the commonest procedure (71) followed by Pyloromyotomy (21), Inguinal hernia repair (15), Ovarian cystectomy (06) and Diaphragmatic hernia repair (03). Six cases needed conversion, port-site infection occurred in 5 cases and incisional hernia in one. Six cases of Georgeson’s operation developed sepsis needing colostomy and three (2.56% of total neonates) of them died. Follow up was from 3 months to 5 years. Twenty three out of 60 successful Georgeson’s operations had peri-anal excoriation persisting for initial 2-3 weeks. Forty six cases are now having normal bowel habits, seven having constipation, five occasional soiling and two fecal incontinence. One (6.66%) inguinal hernia recurred. Overall 70% had uneventful outcomes and 9.4% had serious complications including death.Conclusions: Laparoscopy can be done in neonates using basic instruments with reasonable outcomes in a developing country settingJ. Paediatr. Surg. Bangladesh 4(1): 5-10, 2013 (January)

Simultaneous cecal volvulus and gastric erosion secondary to laparoscopic adjustable gastric band

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric surgical procedure, and therefore, an understanding of its potential problems is imperative. Band complications are well-documented because of their relative frequency: Slippage and pouch dilation occur in up to 25% of patients [1], and the band may erode through the stomach, as reported in 1–5% of cases [2,3]. Port site problems, including pain, infection, disconnection, and leakage, are also experienced by many patients. Rarely, tubing connecting the port to the gastric band creates serious complications. Small bowel obstruction and/ or strangulation occurs when tubing wraps around mesentery, cutting off blood supplying the associated segment of bowel [3,4]. Similarly, cecal volvulus is extremely rare but reported in a few cases [5–7]. These complications likely result from the tendency to leave extra tube length to simplify potential future operations [5]. We present a patient with simultaneous cecal volvulus and gastric erosion 8 years post-LAGB.

Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre

BackgroundBariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach....

Percutaneous Arthroscopic Calcaneal Osteosynthesis: A Minimally Invasive Technique for Displaced Intra-Articular Calcaneal Fractures

The management of calcaneal fracture remains challenging. Open surgery has been fraught with high infection rates and soft tissue complications. More minimally invasive procedures have reduced this risk, but the patient outcomes after treatment of displaced calcaneal fractures have remained relatively unsatisfactory. We present a method for the management of Sanders grade II and III calcaneal fractures: percutaneous arthroscopic calcaneal osteosynthesis. Thirty-three fractures in 30 patients who had presented to our tertiary foot and ankle trauma center in central London were treated with percutaneous arthroscopic calcaneal osteosynthesis for calcaneal fractures, and the data were prospectively collected. The mean patient age at injury was 39 years. The mean follow-up period was 24 months. Of our patients, 58% were smokers at injury. Of the 33 fractures, 46% were classified as grade II and 54% as grade III. The mean length of stay was 1.92 days. At the final follow-up visit, the mean Böhler angle had increased from 11.10° (range 2° to 24°) to 23.41° (range 15° to 35°). The modified American Orthopaedic Foot and Ankle Society scale score was 72.18 (range 18 to 100), the calcaneal fracture scoring system score was 79.34 (range 42 to 100), and the visual analog scale score was 29.50 (range 0 to 100). We had a single case of a superficial port site infection and 2 cases of prominent screws, which were removed. No cases of deep infection developed, and no conversion to subtalar fusion was required. This technique significantly reduced the incidence of postoperative wound complications. Direct visualization of the fracture site allowed accurate restoration of the articular surface and correction of heel varus. Furthermore, it was associated with a high self-reported functional outcome and a return to preinjury employment levels. Also, the results did not appear to be influenced by tobacco consumption.

Laparoscopic Interrupted Muscular Arch Repair in Recurrent Unilateral Inguinal Hernia Among Children.

We present a procedure of suturing the transversus abdominis muscular arch to the ileopubic tract laparoscopically in order to repair recurrent unilateral pediatric inguinal hernia (PIH). Twenty-five children with recurrent unilateral PIH were treated during a 5-year period in a tertiary academic center. All cases were subjected to laparoscopic hernia repair and discharged the next morning. Sutures were placed from the muscular arch to the ileopubic tract, avoiding the spermatic vessels and duct, in an interrupted manner using 2/0-3/0 polypropylene (Prolene®; Ethicon, Somerville, NJ) or polyglactin 910 (Vicryl®; Ethicon) sutures. In 4 cases, a rectangular purse-string-like suture was added to narrow the internal ring defect. Operative findings and postoperative results and complications were assessed. The patients were followed up for a period that ranged between 6 and 60 months. There were 23 boys and 2 girls. Operative age ranged between 18 months and 15 years. Three or four sutures were placed in each case. In 4 cases, an additional rectangular purse-string-like suture was added. Operative time ranged between 35 and 70 minutes, and there was no conversion. Mild scrotal edema was reported in 4 cases and port-site infection in 2 cases; all cases were treated conservatively. One case of recurrence among boys was reported, but there was no case of testicular atrophy. Cosmetic outcomes were excellent. Laparoscopic interrupted muscular arch repair is a feasible and safe technique in the reconstruction of the inguinal canal in recurrent unilateral PIH. Larger studies and long-term follow-up are needed to support our encouraging results.

English

Port site infection is a frequent problem encountered in patients undergoing laparoscopic surgery. The milestone which minimal invasive surgery achieved since its inception is that laparoscopic Cholecystectomy has become gold standard. Umbilical port site infection during cholecystectomy is reported to be 9%,(1, 2) even for difficult cholecystectomy.(3) The role of topical antibiotic prophylaxis is particularly useful in prevention of local infection in all patients especially those taking immunosuppressive drugs, uncontrolled diabetic patients, and others. In the literature, no data shows differences in umbilical port site infections in Lap. Cholecystectomies who undergo different techniques of peritoneal access: Hasson, Veress, and others. (4, 5) However, the incidence of port site complications has shown a proportional risk with the increase in size of port size incision & trocar(6, 7) Surgical site infection is because of microbial contamination of the surgical wound . The microorganisms may originate from either endogenous or exogenous sources. Sources of endogenous flora include the patient's skin, mucous membranes or hollow viscera. Exogenous flora originate from any contaminated items on the sterile surgical field including, surgical team members, instruments, air, or material(8) In this study, we concentrated on the management and prevention of laparoscopic port site infection. The aim of this study was to evaluate the use of Trocars & Stillets soaked in 10% topical povidone-lodine solution for prevention/lowering of laparoscopic port site infections.

A purse-string suture at the level of internal inguinal ring, taking only the peritoneum leaving the distal sac: is it enough for inguinal hernia in pediatric patients?

Although laparoscopic surgery in children has expanded in recent years. Laparoscopic hernia repair in children is still debatable. We aimed to summarize and describe our results of laparoscopic inguinal hernia repair and techniques among children. Between March 2011 and April 2013, 98 children (67 male, 31 female) underwent laparoscopic inguinal hernia repair at the department of surgery. The clinical outcomes were collected retrospectively. The mean follow-up period was 22.6months. Twelve patients were ex-premature infants and a contralateral patent processus vaginalis (PPV) was present in 37 of the 91 unilateral inguinal hernia patients. There were two postoperative complications (transient hydrocele, umbilical port site infection). The mean operative time was 46min. Recurrence, metachronous hernia and testicular atrophy were not observed during the follow-up period. Our preliminary experiences suggest that the laparoscopic purse-string suture of internal inguinal opening of hernia sac could be a safe, effective, and reliable alternative for management of pediatric inguinal hernia.

Port site infection in laparoscopic surgery: A review of its management.

Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.

Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study.

BACKGROUND:Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure.PATIENTS AND METHODS:All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded.RESULTS:All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period.CONCLUSIONS:SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly.

Day-case laparoscopic cholecystectomy.

Objectives:To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure.Methods:All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology (ASA) grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed.Results:A total of 487 patients underwent laparoscopic cholecystectomy as a day case (ASA I=316, ASA II=171). Surgery was performed by high surgical trainees (HSTs) (n=417) and consultants (n=70) with conversion to open cholecystectomy in 4 patients. Twenty-two (5%) patients were admitted for overnight stay for different reasons, while 465 (95%) patients were discharged before 8 pm. Two patients (0.4 %) were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection (1%). A total of 443 patients were satisfied (97%), while 14 (3%) were unsatisfied. There was no mortality or intra-abdominal septic collection.Conclusion:Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management.

Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria.

Background:Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre.Patients and Methods:A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis.Results:Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies.Conclusion:Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings.

Laparoscopic High Ligation of Hernia Sac of Inguinal Hernia in Pediatric Patients

Purpose: Although laparoscopic surgery in children has expanded in recent years. laparoscopic hernia repair in children is still debatable. We aimed to summarize and describe our results of laparoscopic inguinal hernia repair and techniques among children. Methods: Between March 2011 and August 2013, 117 children (81 male, 36 female) underwent laparoscopic inguinal hernia repair at the department of surgery. The clinical outcomes were collected retrospectively. Results: The mean follow-up period was 26.2 months. Thirteen patients were ex-premature infants and a contralateral patent processus vaginalis (PPV) was present in 44 of the 110 unilateral inguinal hernia patients. There were two postoperative complications (transient hydrocele, umbilical port site infection). The mean operative time was 47 minutes. Recurrence, metachronous hernia, and testicular atrophy were not observed during the follow-up period. Conclusion: Our preliminary experiences suggest that the laparoscopic purse-string suture of internal inguinal opening of the hernia sac could be an effective and reliable alternative for management of pediatric inguinal hernia.

Laparoscopic Gastric Band Erosion: A Retrospective Analysis and Review of Management

Background: Laparoscopic gastric banding is a well-tolerated bariatric operation with low morbidity and mortality. The management of gastric band erosion has not been well described. A review of the management of gastric band erosions occurring at our institution was conducted. Methods: Operative records were reviewed retrospectively, identifying the total number of gastric bands placed, as well as any operations performed for gastric band erosions. Results: During 2006–2009, 2,570 gastric bands were placed, and 17 gastric band erosions were managed. Management consisted of removal of the band and port device, and either primary closure of the defect or intraluminal placement of a drain. Fifty percent of patients with erosion presented with port-site infections. Conclusion: We conclude that placement of an intraluminal drain is more than adequate for gastric band erosion. We further conclude that when port-site infections occur, especially late, a work-up for erosion is indicated.

One-stage robotically assisted laparoscopic biliopancreatic diversion with duodenal switch: analysis of 179 patients

BackgroundBiliopancreatic diversion with duodenal switch (BPD-DS) has been reported to be the most effective procedure for weight loss and minimizing postoperative weight regain. However, because of its technical complexity and concerns for higher operative and metabolic complications, it has not obtained widespread acceptance among patients or bariatric surgeons. Nevertheless, the use of robotic systems has been increasing because of its ability to overcome technical challenges, such as torque, freedom of movement, and precision. The objective of this study was to review the efficacy and safety of robotic assistance in laparoscopic BPD-DS. MethodsA prospectively maintained database of patients who underwent robotic-assisted laparoscopic BPD-DS between 2008 and 2013 was reviewed retrospectively. ResultsA total of 179 consecutive patients (137 female and 42 male) were included in the study. The mean age was 44 years (20–72 yr). Mean body mass index (BMI) was 50.3 kg/m2 (35–78.8 kg/m2), and the number of preoperative co-morbidities was 6.6 (2–14). Mean operative time for a typical BPD-DS with appendectomy was 249 minutes (162–413 min), which increased to 278 minutes (193–463 min) in adhesiolysis associated cases and increased to 272 minutes (186–431 min) if additional procedures, such as hiatal hernia repair, cholecystectomy, or Meckel’s diverticulum resection, were included. All procedures were completed as a single-stage operation. There were no major intraoperative complications. Two patients had unexpected returns to the operating room during the same admission: one for an endoscopic release of an inadvertently sutured nasogastric tube and the other for port site infection. Median hospital stay was 2.7 days (1–13). Two patients had significantly longer stays for carpal tunnel syndrome exacerbation (9 d) and port site infection (13 d). Postoperatively, the median excess weight loss at 1, 3, 6, 9, 12, 18, 24, and 36 months with follow-up of 71% of patients at 1 year, 45% of patients at 2 years, and 15% of patients at 5 years, was 19%, 35.9%, 53.1%, 65.6%, 74.6%, 79.9%, and 75.8%, respectively. Diabetes, hypertension, and hyperlipidemia went into remission 95.5%, 92.1%, and 92% of the time, respectively. No mortality occurred. ConclusionsRobotically assisted duodenoileal anastomosis during laparoscopic BPD-DS is a feasible, well-tolerated, and effective alternative to assist in the technically challenging part of the operation.

Safety of laparoscopic adjustable gastric banding with concurrent cholecystectomy for symptomatic cholelithiasis.

The prevalence of cholelithiasis correlates with obesity. Patients often present for bariatric surgery with symptomatic cholelithiasis. There is a concern of cross-contamination when performing laparoscopic adjustable gastric banding (LAGB) with concurrent cholecystectomy. The primary goal of this study is to address the safety and feasibility of this practice. A retrospective cohort study was designed from a prospectively collected database. All LAGB patients from July 2005 to April 2013 were included. Patients undergoing LAGB with concurrent cholecystectomy comprised the study group (LAGB/chole). The control group (LAGB) consisted of patients undergoing LAGB alone, and was selected using a 3:1 (control:study) case-match based on demographic and comorbidity data. The primary outcome was overall complication rate, with secondary outcomes including operating room (OR) time, length of stay (LOS), 30-day readmission/reoperation, erosion, infection, and band/port revisional surgery. There were 4,982 patients who met criteria. Of these, 28 patients had a LAGB with concurrent cholecystectomy, comprising the LAGB/chole (study) group. The remaining 4,954 patients were eligible controls, of which 84 were selected for the LAGB (control) group. Demographic and comorbidity data, along with mean follow-up time, were similar between the two groups. OR time was longer in the LAGB/chole group, but LOS was the same. The overall complication rate in the LAGB/chole group was 21 (n = 6) versus 20% (n = 17) in the LAGB group (p = 0.893). Thirty-day readmission and reoperation were similar. There was also no difference in port site, wound, and intra-abdominal infections. There were no band erosions in either group. Performing a concurrent cholecystectomy at the time of LAGB does not result in increased immediate or delayed morbidity. Although longer to perform, this safe operation would avoid a second surgery for a patient already diagnosed with symptomatic cholelithiasis.

Endoscopic management of gastric band erosions: a 7-year series of 14 patients

Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter. Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric penetration of the connecting tube broken close to the band. The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.