Codification of techniques for reoperation after Lap-Band®

Background: The Lap-Band is a safe, reversible, minimally invasive, and effective bariatric technique, whose main late complications are herniation/dilation of the pouch, erosion/migration of the band, and problems with the adjustment system (subcutaneous access port and connection tubing). We describe the surgical timing and techniques for dealing with the principal complications. Methods: Between October 1995 and September 2001, we treated 540 patients (mean age 43 years, mean BMI 42.6 kg/m(2)). All operations were,completed laparoscopically, with no intra-operative complications or mortality. Late complications were: problems with the band adjustment system (n=35); herniation/dilations of the pouch (n=14); erosions/migration of the band into the stomach (n=3). Results: We dealt successfully with all complications using a minimally invasive technique. Herniation/dilations of the pouch necessitated 15 successful repositionings of the band, and 2 removals of the band at the patients' request. Erosion/migration was treated by endo-laparoscopic band removal. Problems with the band adjustment system had to be corrected laparoscopically, under general anesthesia in 17 patients. Conclusion: While emphasizing the rarity of complications, we have codified re-operation techniques to help Lap-Band users solve them using a minimally invasive procedure. In particular, problems with the port and connection tubing system can be completely avoided with a transverse subcutaneous positioning in a straight line.