IBC Oxford University Oral Abstract 15 - Video abstract: management of intra-thoracic band slippage and severe GERD following laparoscopic adjustable gastric banding: a video case study

Abstract Introduction As a bariatric procedure, laparoscopic adjustable gastric banding (LAGB) led to an increased prevalence of complications, including gastroesophageal reflux disease (GERD), band slippage and dysphagia. This explains the high reported failure rate. This video abstract presents the management of an intra-thoracic band slippage associated with severe GERD. Methods A 53-year-old man with a history of morbid obesity, underwent LAGB 19 years prior. Despite initial weight loss (BMI = 51 kg/m2 to 22 kg/m2), he presented with symptomatic GERD and vomiting. Investigations revealed intra-thoracic band slippage with a portion of the stomach herniated into the chest cavity. Laparoscopic removal of the gastric band was carried out after careful dissection of the hiatal region. Afterwards, the oesophagus was mobilised, and the hernia sac was dissected and excised down to the anterior wall of the oesophagus and around the gastroesophageal junction. Closure of the crura was performed using non-absorbable sutures and was followed by placement of a Toupet fundoplication. Results The operative time was 130 minutes. The patient was allowed oral liquids after one postoperative day and subsequently discharged on second postoperative day. There were no postoperative complications. The patient experienced resolution of GERD symptoms, and no weight regain at 9 months follow-up (BMI: 26 kg/m2). The surgical methods used in this instance are given in the accompanying video, which also offers insightful information about the steps of the procedure. Conclusions This case highlights the feasibility and efficacy of removal of the laparoscopic adjustable gastric band combined with Toupet fundoplication. Revisional bariatric surgeries should probably be reserved for cases when GERD is associated with weight regain.