Does Laparoscopic Gastric Banding Demand Sophisticated Measurement Devices?

BACKGROUND: One of the most frequently discussed issues used and a free space for the tip of the Endo-Babcock in gastric banding is the Problem of intraoperative upper gastric Pouch volume assessment and the calibration of the connecting stoma diameter. Having experience with more than 200 adjustable and non-adjustable laparoscopic gastric bandings in last 3 years, we started to study whether it is possible to assess the Pouch volume and stoma diameter by relying on anatomical landmarks and simple bougie calibration, rather than on sophisticated measuring devices. METHODS: We compared results of Postoperative pouch volume control measurements in a group of patients in whom a balloon method of Pouch volume measurement was performed during the gastric banding with a group of patients where no intraoperative measurements of the upper gastric pouch were done. In the latter group the Pouch volume was assessed according to the anatomical landmarks during the dissection: the cardia at the lesser curvature and the avascular area of gastrophrenic ligament at the greater curvature. In both groups endoscopic study 2 weeks following surgery was performed. Concerning stoma diameter we started with a prospective randomized study of two groups. In the first group, we intraoperatively measured by manometry the inside-stoma pressure. In the second group, a simple bougie calibration was used, and a space was left for the tip of the Endo-Babcock instrument between the stomach wall and the band. Postoperatively, the stoma diameters were compared, using the 'balloon catheter pulled through the stoma' method. RESULTS: Pouch volume: in the group operated according to surgeon's assessment of the anatomical landmarks, 96% of the patients' pouch volume did not exceed 60 ml at 2 weeks postoperative checkups The results were no different from the group of patients where intraoperative volume measurements were performed. The stoma diameter: a group of patients where intraoperative stoma pressure measurements were performed and a second group where a simple calibration bougie was instrument was left between stomach wall and band were compared prospectively. There was no statistical difference between the two groups in stoma diameter measured 2 weeks after operation by the 'balloon pull through' method. CONCLUSIONS: It is possible to rely on anatomical landmarks in constructing the upper gastric pouch. Postoperatively, five volume measurements did not show any statistical difference between the group in whom intraoperative Pouch volume measurements were performed and the group where anatomical landmarks were used. There was no statistical difference in postoperative stoma diameter measurements between the group where intraoperative stoma pressure measurements were performed before Closing the band and the group where just a calibration bougie was used and a free space for the tip of an endoscopic instrument was left between stomach wall and band. These measurements were made with the non-adjustable band. With the adjustable band, the stoma diameter measurements would be even less important.