DOES LAPAROSCOPIC GASTRIC BANDING DEMAND SOPHISTICATED MEASUREMENT DEVICES

Background: One of the most frequently discussed issues in gastric ban ding is the problem of intraoperative upper gastric pouch volume asses sment and the calibration of the connecting stoma diameter, Having exp erience with more than 200 adjustable and non-adjustable laparoscopic gastric bandings in last 3 years, we started to study whether it is po ssible to assess the pouch volume and stoma diameter by relying on ana tomical landmarks and simple bougie calibration, rather than on sophis ticated measuring devices. Methods: We compared results of postoperati ve pouch volume control measurements in a group of patients in whom a balloon method of pouch volume measurement was performed during the ga stric banding with a group of patients where no intraoperative measure ments of the upper gastric pouch were done, In the latter group the po uch volume was assessed according to the anatomical landmarks during t he dissection: the cardia at the lesser curvature and the avascular ar ea of gastrophrenic ligament at the greater curvature. In both groups endoscopic study 2 weeks following surgery was performed, Concerning s toma diameter we started with a prospective randomized study of two gr oups, In the first group, we intraoperatively measured by monometry th e inside-stoma pressure, In the second group, a simple bougie calibrat ion was used, and a space was left for the tip of the Endo-Babcock ins trument between the stomach wall and the band, Postoperatively, the st oma diameters were compared, using the 'balloon catheter pulled throug h the stoma' method. Results: Pouch volume: in the group operated acco rding to surgeon's assessment of the anatomical landmarks, 96% of the patients' pouch volume did not exceed 60 ml at 2 weeks postoperative c heck-up, The results were no different from the group of patients wher e intraoperative volume measurements were performed, The stoma diamete r: a group of patients where intraoperative stoma pressure measurement s were performed and a second group where a simple calibration bougie was used and a free space for the tip of the Endo-Babcock instrument w as left between stomach wall and band were compared prospectively, The re was no statistical difference between the two groups in stoma diame ter measured 2 weeks after operation by the 'balloon pull through' met hod. Conclusions: it is possible to rely on anatomical landmarks in co nstructing the upper gastric pouch, Postoperative volume measurements did not show any statistical difference between the group in whom intr aoperative pouch volume measurements were performed and the group wher e anatomical landmarks were used, There was no statistical difference in postoperative stoma diameter measurements between the group where i ntraoperative stoma pressure measurements were performed before closin g the band and the group where just a calibration bougie was used and a free space for the tip of an endoscopic instrument was left between stomach wall and band. These measurements were made with the non-adjus table band. With the adjustable band, the stoma diameter measurements would be even less important.