Posterior prolapse: An important entity even in the modern age of the pars flaccida approach to lap-band placement

Background: The most prevalent long-term complications in patients who undergo laparoscopic adjustable gastric band (LAGB) surgery are pouch dilatation and gastric prolapse (slippage). Gastric prolapse can be divided into the anterior and posterior variety. Posterior prolapse is thought to be specific to the perigastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior prolapse. Methods: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior prolapse requiring reoperation. Results: All 3 patients presented with similar complaints, including solid food intolerance, gastroesophageal reflux and/or regurgitation. Although identical to those reported with anterior prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. Conclusion: The finding of 3 patients who experienced posterior prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.