Optimization of access-port placement for the LapBand® system

Background: The technical aspects of access-port (AP) placement are not generally described in LapBand(R) series. Methods: From November 2000 to April 2002, we performed Lap-Band(R) procedures laparoscopically on 180 patients. A retrospective review was conducted of 3 consecutive AP-placement techniques in nonselected and demographically identical groups. In Group A (n=48, Nov. 2000 to July 2001), the AP was placed at the left subcostal margin. In Group B (n=23, Aug. 2001 to Sept. 2001), the AP was tunneled over the subcostal fascia towards the subxiphoid area. In Group C (n=109, Oct. 2001 to Apr. 2002), the AP tubing was tunneled over the subcostal fascia and connected to the AP, which was inserted through a 3-cm subxiphoid incision. Results: AP-related problems occurred within the first few months following surgery. In Group A, 24 of the APs (50%) were tilted, and 14 (29%) were completely flipped over. 11 APs (23%) were found to be broken. 19 patients (40%) underwent an additional AP-related procedure. In group B, 12 APs (52%) were tilted and 1 patient required surgery to turn the AP. In Group C, 8 APs (7%) were turned slightly. 1 AP was found to be broken and required surgery to replace it. In this group, all APs were accessible for adjustment in the office. Conclusions: Tunneling the AP along the left subcostal area is an important technique to protect the AP system from breakage, by changing AP-tube position from vertical to horizontal in relation to abdominal wall movement. This technique also keeps the AP-tube connection over the fascia and protects it from "wear and tear" forces. The addition of fixation at the subxiphoid location helps maintain a straight orientation of the AP for easier adjustments.