What is a Lap-Band? A restrictive gastric banding procedure was first introduced in 1983 made adjustable in 1986 made available laparoscopically in the.

What is a Lap-Band?A restrictive gastric banding procedure was

first introduced in 1983made adjustable in 1986made available laparoscopically in the early

1990ssilicone band around upper stomach to

create small gastric pouch and narrow stoma that communicates with remainder of stomach

LAGBsilicone band has adjustable inner balloon cuff

and subcutaneous injection reservoir sutured to anterior rectus sheath

pouch volume created typically 15 cm3initial stomal size approx. 12 mm diameterLAGB can adjust to the patient’s situation

without need for additional surgeryinner balloon inflated to maximal volume of 5

cm3, and ideal stomal size is 3 to 5 mm

Routine early postoperative UGI evaluation after LAGB to assess for extraluminal leak or obstruction

placement of the band, pouch size, and stoma size may be assessed

From Obesity Surgery, 13, 901-908 “Because of the difficulty that obese patients have in changing position, we always used the upright position, except for performing plain abdominal film (supine position), or evaluating gastric integrity on the first postoperative day (left lateral decubitus), or for checking any device leakage (supine position).”

Initial Early post-op UGIInitial supine scout to locate band, port and

tubing, assure contiguity and positionStraight AP or slightly RPO to move fundus to

left then move to place band in profileFirst check for leak, then give barium and watch

for: small gastric pouch, small stoma, filling of stomach

May be mild delay in esophageal emptying, especially in early post-op

One study reported 45 degree positioning (RSNA)

Adjusting the stomaAdjustments usually performed 6 weeks post-

op, once edema has resolvedWith Lap-Band system, stoma size decreased

by 0.5 mm following addition of 0.4 cm3 of saline

Center of port localized at fluoroscopy in supine position

Radiopaque marker placed, skin prepped with antiseptic, local anesthesia

20- to 22-gauge noncoring, deflected-tip needle to access the port

Early complicationsEarly complications are rareGastroesophageal perforation in <0.5%Improper positioning at surgery/post-op

slippage requiring repositioning less than 1%Acute stomal obstruction 1.4%Early dysphagia in up to 14%Regurgitation and pouch esophageal reflux

are common until dietary habits change

Late complicationsMost common long-term complications:

pouch dilatation (25%) and slippage (24%) of gastric band

Other significant late complications include: intragastric band migration or erosionacute obstructiondevice-related complications resulting in

leakage of saline from the system or infectionGastric necrosis- rare complication of LAGB

(<0.3%) due to slippage with strangulation

(a) A 39-year-old woman during fluoroscopy showing eccentric pouch (arrowheads) dilatation due to posterior band slippage. Note the abnormal band orientation (arrows). (b) After surgery the normal orientation of the band has been reconstituted with a small proximal neostomach.

Clinical Radiology (2004) 59, 227–236

10 mos laterInitial postop

1 mo later-no intervention

ReferencesClinical Radiology (2004) 59, 227–236Radiol Clin N Am 45 (2007) 261–274Obesity Surgery, 13, 901-908Radiology 2000; 216:389–394Eur Radiol. (2001) 11: 417-21Videos courtesy of Mark Wulkan