Management of Complications Related to Laparoscopic Adjustable Silicone Gastric Band

Laparoscopic adjustable silicone gastric band (LASGB) is frequently used to treat morbidly obese patients worldwide. Complications related to this procedure have increased as the follow-up interval of these patients has increased. Treatment of these complications often includes removal of the silicone band. Herein we report our experience with silicone gastric band removal, discuss the different treatment alternatives, and present a management algorithm. A retrospective review of complications related to LASGB was made from June of 2003 to April of 2010 (eight patients). Techniques of band extraction are discussed and a management algorithm is presented. The mean Body Mass Index at the time of LASGB placement was 39.45 (Range 34.2 - 42.8). The median patient’s age at the time of LASGB was of 32.6 years (range: 13 to 50 years). The average durability of the silicone band after laparoscopic placement was 67.8 months (range: 6 to 120 months). In three patients (37.5%) the LASGB had perforated the gastric wall and was therefore extracted using a transgastric approach (laparoscopic in two patients and by laparotomy in one patient). In five patients the silicone band had not perforated the stomach and was therefore removed laparoscopically without entering the stomach. The weight was recovered in 37.5% of the patients during follow-up. Management of patients with complications related to LASGB placement must be individualized and should address both the band related complication as well as the obesity problem. Laparoscopic trans-gastric band extraction is ideal when the LASGB has eroded into the stomach and endoscopic extraction is not feasible.