Laparoscopic removal of a migrated intragastric lap-band®

This is the case of a 40-year-old female patient who had a gastric band placed in 2000. A few years later, after failure of the band, complementary examinations were carried out. They raised the suspicion of an intragastric migration of the band. The laparoscopic removal of this migrated band is presented.

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Laparoscopic removal of a migrated intragastric lap-band®

Authors

V Podelski, M Vix, J Marescaux

Abstract

This is the case of a 40-year-old female patient who had a gastric band placed in 2000. A few years later, after failure of the band, complementary examinations were carried out. They raised the suspicion of an intragastric migration of the band. The laparoscopic removal of this migrated band is presented.

Type de vidéo

Vidéo chirurgicale

Durée

17'42''

Publication

2011-04

Popularité

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Sous-titres

E-publication

WeBSurg.com, Apr 2011;11(04).
URL: http://www.websurg.com/doi-vd01en3202.htm

Laparoscopic removal of a migrated intragastric lap-band®

1. Clinical case presentation 00'19''

This is the case of a 40-year-old female patient who had a gastric band placed in 2000. A few years later, after failure of the band, complementary examinations were carried out. They raised the suspicion of an intragastric migration of the band.

2. Dissection of adhesions 00'41''

When re-intervention is planned in this type of patients, the first step consists in freeing all the intra-abdominal adhesions, which are fairly dense in this patient. It is essential to find an adequate operative plane, which makes it possible to identify the gastric structure. The Ligasure® vessel-sealing device may be very useful in taking down these adhesions without any bleeding. Adhesions are partly taken down to create sufficient dissection space, identify anatomical landmarks in the gastric region, and introduce the different ports.

3. Landmark stitches on gastric wall 01'39''

When the stomach and the anterior aspect of the stomach have been freed, two landmark stitches are placed on each side of the space where one port will be introduced in the gastric wall. Entrance in the intragastric space will then be achieved in order to undertake the exploration and initiate the removal of the gastric band. Here, in order to give more space to the gastric wall, a few more adhesions are taken down on the side of the greater curvature, and decision is made to free the catheter so as to identify the band’s closure mechanism and facilitate its removal.

4. Gastric wall opening 02'35''

The gastric wall is opened between the two landmark suspension stitches.

5. Ballon port insertion 02'45''

A balloon-tipped port will be introduced directly into the stomach. The balloon will be inflated, hence allowing to retract the gastric wall while ensuring parietal patency.

6. Second opening 03'03''

Once this has been achieved, part of the stomach is inflated and a second opening is created to allow for the introduction of a forceps or scissors inside the stomach. As a result, another operative space is created within the stomach. By entering this space, one may find out that the insufflation is not optimal but allows to place two instruments inside the gastric cavity and to easily identify the migrated band inside the stomach. The band’s closure mechanism has completely entered the stomach. Three openings are identified, one for the entrance of the band and one for its exit, and another for the entrance of the catheter.

7. Catheter and band cutting 04'06''

The catheter and the band are both cut so as to be re-introduced into the gastric cavity.

8. Catheter removal 04'18''

The catheter is also removed by taking out one of the graspers. The gastric wall is freed from its omental adhesions. A first stitch is placed on removing the catheter. It will be used as a landmark.

9. Closure of the second opening 04'45''

The introduction site of the right grasper is now closed. Scissors are introduced to the right. Two absorbable threads are placed so as to completely close the opening. Three stitches are then placed. They may be slightly shortened in order to completely close the opening. The landmark stitches, which had been anchored on both sides of the first gastric opening, and which contained the balloon trocar, are removed.

10. Band removal 05'49''

The gastric band is removed through this opening, which is the most important one of all. The band is immediately placed in a bag. This bag will be removed at the end of the procedure.

11. Closure of the first opening using the Endo-GIA linear stapler 06'11''

The gastric opening is quite large here. The anterior gastric wall will be closed using a 60mm Endo-GIA linear stapler, blue cartridge. The introduction site of the left grasper will also be closed using some separate stitches. The resected portion of the stomach is also introduced in the bag. A running suture is placed to cover the anastomosis. A covering running suture of the stapling line is placed using absorbable monofilament threads. The last opening, which had allowed for the introduction of a grasper in the stomach, is now closed. A nasogastric tube is introduced by the anesthesiologists. The bag will be removed and a drain will be placed on the anterior and posterior surfaces of the stomach.