The technical approach in banding to avoid pouch dilatation

Adjustable gastric banding results in good weight loss. Nevertheless, some complications may occur, including slipping of the stomach through the band with pouch dilatation. Initially, the Belachew and Cadière technique was done with the Lap-Band. Afterwards, to minimize proximal gastric pouch dilatation (GPD), we performed the operation using the Swedish route with the same band (Inamed).

In a retrospective study, 139 consecutive adjustable gastric bands were placed laparoscopically between December 1994 and March 2000. Mean age was 37 years. 10.3% were male. Mean BMI was 39.7. Until April 1999 (Group I, n = 104), the band was introduced according to Belachew's and Cadière's technique (intragastric balloon calibration technique). Starting May 1999 (Group II, n = 35), the Lap-band was introduced using the Swedish route. This technique consists of localizing the right and left crus posteriorly. A tunnel is created behind the cardia and right above the crus after transsection of the gastrophrenic ligament. The Lap-band is introduced as well as an anterior intragastric calibrating balloon with an air chamber at its distal end, making a pouch 5 to 10 cc.

In group I, 15.4% had GPD needing re-hospitalization. Of these, 75% required a re-operation. In group II, no slipping nor pouch dilatation has been reported so far.

The Swedish route appears to be the key to avoiding GPD. By introducing an intragastric calibrating balloon with a pouch of 5 to 10 cc anteriorly, the band is placed just below the cardia, and no pouch dilatation has been found. The important factor may not be the type of band but rather the technical approach.