The technical approach in banding to avoid pouch dilatation

Background: Adjustable gastric banding results in good weight loss. Neverth eless, some complications may occur, including slipping of the stomach thro ugh the band with pouch dilatation, Initially, the Belachew and Cadiere tec hnique was done with the Lap-band(R). Afterwards, to minimize proximal gast ric pouch dilatation (GPD), we performed the operation using the Swedish ro ute with the same band (Inamed). Methods: In a retrospective study, 139 consecutive adjustable gastric bands were placed laparoscopically between December 1994 and March 2009. Mean ag e was 37 years. 10.3% were male. Mean BMI was 39.7, Until April 1999 (Group I, n=104), the band was introduced according to Belachew's and Cadiere's t echnique (intragastric balloon calibration technique). Starting May 1999 (G roup II, n=35), the Lapband(R) was introduced using the Swedish route,This technique consists of localizing the right and left crus posteriorly. A tun nel is created behind the cardia and right above the crus after transsectio n of the gastrophrenic ligament,The Lap-band(R) is introduced as well as an anterior intragastric calibrating balloon with an air chamber at its dista l end, making a pouch 5 to 10 cc. Results: In group I, 15.4% had GPD needing rehospitalization. Of these, 75% required a re-operation. In group II, no slipping nor pouch dilatation has been reported so far. Conclusion: The Swedish route appears to be the key to avoiding GPD. By int roducing an intragastric calibrating balloon with a pouch of 5 to 10 cc ant eriorly, the band is placed just below the cardia, and no pouch dilatation has been found, The important factor may not be the type of band but rather the technical approach.