Anterior versus posterior slippage: Two different types of eccentric pouchdilatation in patients with adjustable laparoscopic gastric banding

Purpose: To describe two different types of band dislocation that may occur in morbidly obese patients following adjustable laparoscopic gastric bandi ng (ALGB) with the LAP-BAND. Materials and Methods: 170 morbidly obese pati ents were treated with an LAP-BAND at our institution. In the first 20 pati ents the band was positioned transbursally, which means that the lesser sac is penetrated during laparoscopic band implantation. In the following 150 patients the operation technique was changed to suprabursal band positionin g where the lesser sac is not penetrated. Plain radiographs and single cont rast studies of all patients who developed band instability in the follow-u p were analyzed retrospectively and compared to the clinical and intraopera tive findings and to the operation technique used. Results: Over a time per iod of 3.5 years 'posterior slippage' occurred in all 20 patients with tran sbursal band placement, but it never occurred after suprabursal band placem ent. Nevertheless 4 patients with suprabursal band placement presented with an eccentric pouch dilatation, secondary to 'anterior slippage' after the seromuscular stitches had burst on the anterior and superior surface of the band. All these patients presented with food intolerance and all of them h ad to be reoperated. The radiographic findings were pathognomonic for each type of band dislocation. Conclusion: Band dislocation is a known major com plication that may occur following ALGB and it may present in two different forms. While 'posterior slippage' can be avoided if the band is placed sup rabursally, 'anterior slippage' may still occur. It is important to be fami liar with both types of band dislocation since they require early detection and surgical band replacement or band refixation. Copyright (C) 2001 S. Ka rger AG, Basel.