Laparoscopic revisional surgery for life-threatening stenosis following vertical banded gastroplasty, together with placement of an adjustable gastric band.

BACKGROUND: Vomiting and extreme weight loss may be life-threatening when stenosis develops following vertical banded gastroplasty. Often patients must undergo revisional surgery. Once the stenosis is relieved, the majority of patients will proceed to gain weight at an excessive rate. Placement of an adjustable band during revisional surgery allows us to treat the stenosis while limiting the patients' weight gain and preventing the return of morbid obesity. Performing this operation laparoscopically reduces patient morbidity.

PATIENTS AND METHODS: 23 patients (16 female, 7 male) were referred because of severe food intolerance following silastic ring or Dacron mesh vertical gastroplasty. The patients were on average 1.75 years after the initial operation (range: 9 months - 6 years). All patients required repeat hospitalizations due to excessive vomiting and dehydration. All patients underwent laparoscopic surgery, with placement of an adjustable band in 21 patients.

RESULTS: All operations were performed laparoscopically without need for conversion to laparotomy. There were no intra-operative complications, and all patients were discharged within 24 hours. Patients have been followed for a mean of 7 months (range 3 months to 16 months). All patients became food tolerant without vomiting. 15 patients required inflation of the adjustable band in order to control excessive weight gain.

CONCLUSIONS: Laparoscopic adjustable gastric banding at the time of revisional surgery for stenosis appears to be a safe and effective operation that does not add morbidity to surgery, but does prevent the need for further revisional surgeries when patients begin to gain excessive weight after relief of their obstruction.