Transgastric laparoscopic removal of gastric band

Introduction: Intragastric migration is a severe late complication of the gastric band. Its incidence has been reported to be between 0.5% and 11%. The most common symptoms are weight gain, recurrence port infection, vomits and abdominal pain. The procedure of choice for the removal the gastric band is endoscopy while surgical treatment is reserved for cases in which endoscopy fails. In this video we present an innovative procedure of removal of a migrated band through a laparoscopic transgastric approach.

Material and methods: Clinical case presented a 77 years-old female who underwent a laparoscopic adjustable gastric band (LAGB) four years ago. The BMI before surgery was 39,5 kg/m2. Two years after operation, and due to multiple port infections, port removal was performed in another institution in 2014. For the past year, the patient presented to our hospital with nausea and vomiting (2016) and the BMI was 36 kg/m2. Barium swallow showed an emptying defect in the esophagogastric junction which was consistence with band erosion. Finally, the upper endoscopy showed a partial inclusion of the band in the gastric lumen. The patient was brought to the operation room and under general anesthesia; a new upper endoscopy was performed. After several attempts to remove the gastric band included, the gastroenterologist failed, so a transgastric laparoscopic removal was proposed.
The procedure started with the incision of a suitable point on the gastric wall, which served for the introduction of a 12 mm balloon trocar. This step was performed using a Harmonic Scalpel. This trocar was used to allow the introduction of a 10 mm scope and also to allow the sealing of the stomach to the abdominal wall. Finally, other 5 mm
balloon trocar was inserted into the stomach in the lesser curvature.
Once the balloon trocars were inside the stomach, the location of the gastric band in the gastric lumen at the level of the esophagogastric junction was confirmed after the introduction of the scope, and was then divided with scissors. Finally, the band was removed through one of the holes of the stomach and the gastric wall was sutured with Ethibond 2/0.

Results: Mean operation time was 60 minutes and the postoperative course was uneventful. The patient was discharged within three days. With a follow-up of six months the patient was completely asymptomatic and with a good oral intake.

Conclusion: Although the procedure of choice for the removal of the migrated gastric band is endoscopy, when this is not feasible, removal of the band through a transgastric laparoscopy approach appears to be as a possible alternative.