Recycling the Band and Rehabilitating the Patient Terry Simpson MD FACS Virginia Mason 1991 Classic Band Slip 2 yrs post Lap Band with Complete Obstruction The Lap Band 500000 bands placed in US since introduction in 2001 ID: 429613
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Slide1
Unbuckling the Band
Recycling the Band and Rehabilitating the Patient
Terry Simpson MD, FACS – Virginia Mason 1991Slide2
Classic Band Slip
2
yrs
post Lap Band with Complete ObstructionSlide3
The Lap Band
500,000
bands placed in US since introduction in 2001
Most weight loss surgeons placed bands in their practice
Direct to Consumer Marketing made it the most asked for weight loss operation
Responsible for the Rise in Gastric Sleeve Operations
Difficulty with instructions and follow up had increased rate of band failure compared to band dedicated practicesSlide4
What Won’t Work
Instructing patients that the band will make them “feel full” or “feel satisfied” leads to poor results
This leads to eating fast, loading the stomach pouch above the band and leads to
slips
The patient presented chronically ate fast and noticed reflux and heartburn for the previous two months. GI placed on
NexiumSlide5
Increased pressure in upper pouch leads to pouch dilation as well as a slip of stomach coming up through the band. Either from people eating too fast, or stuffing the upper pouch with food to feel “full.” This leads to reflux, heartburn and
what is called an “early” band slip.Slide6
Classic Band SlipSlide7
Classic Band Slip
Most patient can be treated by removing fluid from the band and placing them on a liquid diet. About 85% improve with this regimen. However, some present with complete obstructionSlide8
Problems with Traditional Repair
Standard revision leaves thinned out pouch that can later perforateRemoval of
band solves the issue but
leads to weight regain
Conversion to
other bariatric
procedures
has a high rate
of complications Slide9Slide10
Lap Band Slip
3876 patients banded, 411 (11%) had band revised for pouch related problems. 2% had band removed. 3% converted to another procedure
Most often treated by removing fluid from the band and placing patients on a liquid diet
If not satisfactory then
patient will require surgerySlide11
Surgical Treatment
Morbidity and Mortality of conversion to gastric sleeve includes 5.5% rate of “leak”
Conversion to RNY has leak rate of 3%
Removal of band solves issue but loss of weight loss tool leads to increased weight gain
The plan is
removing the pressure from the
stomach-
hence, why not unbuckle – a new procedureSlide12
Classic Band SlipSlide13
Unbuckling the band there was a large amount of scar tissue beneath that would not even admit a 32 French (10 mm) gastric tube. After
lysis
easily admits 90 French balloon (30 mm).
Immediate relief in the post operative recovery room, able to drink fluids without reflux or heartburnSlide14
Two Months Later
2 months later- band buckled – op time 12 minutes
Patient able to eat and drink without difficulty now 4 years outSlide15
Unbuckling the Band
63 cases of unbuckling and re-buckling the band done since 2010
Most re-buckled in two months- some re-buckled as long as two years later
No mortality
5 cases needed to be repositioned after two months or more of unbuckling
3 patients had recurrence of slips- all from maladaptive eating behavior
Allowed patients to “keep” their band
Done acutely and allowed patients to be discharged that day or done as an outpatient procedureSlide16
Re-buckling the Band
It is a second procedureTakes less than 20 minutes of operating room time
Allows patient to keep their tool and to be rehabilitated in their eating behavior
Less morbidity and mortality than conversion to other procedures
In two cases new bands were placed as the bands were damaged in the revisionSlide17
New Procedure
Unbuckling and re-buckling the band is a new procedure that has promiseIt involves careful dissection with the scar around the stomach – hence that procedure is called the “Ryan” procedure