Pouch dilatation and slippage after adjustable gastric banding: is it still an issue?

Laparoscopic adjustable gastric banding (LAGB) in France is currently the most common bariatric surgical procedure for the treatment of severe obesity; its most reported complication is band slippage and/or pouch dilatation, which usually requires reoperation. It is highly important to assess whether a change in the operation could improve these results.

From April 1995 to October 2001, 973 patients underwent LAGB in our institution. Since January 1999, our technique changed: the band was positioned according to the so called "pars flaccida technique", ie. around the gastric vessel instead of close to the gastric wall. 511 patients had been operated before this period, and 462 after. Other details in the technique did not change (dissection above the lesser sac, no posterior stitch, three anterior stitches), meaning that potential differences could not be related to a learning curve.

Band slippage occurred in 27 patients of the first group during the first period of 34 months (5.2%), and 5 more afterwards (total 6.2%). Only 3 patients of the second group (0.6%) had a slippage during the same period of time.

Although the problem of band slippage is not likely to be completely solved, changing the technique has made it possible to decrease the rate of this complication. The height or the shape of different types of band also remain under scrutiny.