Laparoscopic adjustable silicone gastric banding - Prospective evaluation of intragastric migration of the Lap-Band

Intragastric prosthesis (Lap-Band. BioEnterics Co., Carpinteria, CA, U.S.A. ) migration is one of the major long-term complications of laparoscopic adj ustable silicone gastric banding. The causes, clinical signs, timing, and o verall incidence of band entrapment have not been prospectively investigate d in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safet y and effectiveness of minimally invasive band removal. Between January 199 6 and June 2000, 148 consecutive patients enrolled in a multidisciplinary b ariatric program underwent laparoscopic adjustable silicone gastric banding . In the follow-up treatment, gastrointestinal endoscopy was performed rout inely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had lo ng-term major complications. Intragastric band migration was observed in ni ne (7.5%) patients. The diagnosis was established by routine endoscopy betw een 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remainin g three patients are under endoscopic surveillance. The results of this stu dy show that routine upper gastrointestinal endoscopy can discover asymptom atic band migrations early. Band erosion did not require emergency treatmen t and can be removed safely by a minimally invasive approach.