Band misplacement: a rare complication of laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is considered to be a very effective minimally invasive procedure for treating morbidly obese patients. Nevertheless, there are numerous complications that a good surgeon should be aware of. Most of them have been widely presented in the literature.

In this study we would like to focus on the rare but important complication which is ante-gastric positioning of the band.

Between January 2005 and May 2008, 122 patients (88 female and 34 male) with mean body mass index (BMI) of 48.5 kg/m(2) (range 35-80 kg/m(2)) underwent LAGB procedure. The average time of hospitalization was 2.47 days. The first radiological control with band calibration was performed 6 weeks after the operation. Consecutive follow-up depended on the percent excess weight loss (EWL%).

Of the 122 patients, 4 (3.3%) presented herein had a band misplaced in the ante-gastric position. There were three out of five surgeons who faced complications of this type. The most and the least experienced team members avoided misplacing the band. Two physicians encountered it at the beginning of their learning curve, and for one it was not related to the process of education. Among other postoperative complications there were two incidents of band slippage, 2 patients had their port localization corrected and in one case drain disconnection occurred. There were no mortalities.

Ante-gastric positioning of the band was the most common cause of obesity surgery failure in our group of patients. It was very difficult to recognize during the typical postoperative checkups; hence there arose a question whether it has been disregarded in other studies.