Adjustable laparoscopic gastric band for the treatment of morbid obesity: radiologic evaluation

This article describes the radiographic appearance of a recently developed laparoscopically placed adjustable gastric band for the treatment of morbid obesity. The optimal technique for contrast evaluation of the device, complications associated with its use, and the technique for stoma adjustments are also discussed.

Between May and December 1996, 23 patients at our institution underwent laparoscopic placement of adjustable silicone gastric bands for treatment of morbid obesity. All patients underwent a barium upper gastrointestinal series before surgery, 1 day after band placement, at variable intervals when each patient returned for band adjustment, and at 1 year.

Unlike the case in other gastric weight loss procedures, the optimal patient position for contrast evaluation of gastric bands was anteroposterior or slightly right posterior oblique. Twenty-one of 23 patients had no complications shown on the postoperative upper gastrointestinal series. Stoma size was approximately 3-8 mm, and most patients showed delayed esophageal emptying without obstruction. Two patients had herniation of the stomach through the gastric band with pouch enlargement, resulting in obstruction and the need for additional surgery. We saw no leaks or band erosions. Nineteen stoma adjustments were performed in 13 patients. One patient had an inverted port that could not be accessed for adjustment.

As adjustable gastric bands become more widely used, radiologists need to be familiar with the radiographic appearance of the devices, the complications associated with their use, and the optimal patient positioning for contrast evaluation. Radiologists may also be involved with band adjustment to decrease or increase the stoma size and therefore need to understand the technique and potential difficulties of adjusting the stoma.