All strictures are not alike: Laparoscopic removal of nonadjustable Silastic bands after banded Roux-en-Y gastric bypass

James M. Swain, Paul Scott, Elizabeth Nesset, Michael G. Sarr

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background The concept of a nonadjustable Silastic band (NASB) has been used to promote surgically induced weight loss for >30 years. Vertical banded Roux-en-Y gastric bypass is an example. Some patients develop serious, band-related complications requiring treatment. Narrowing at the NASB will lead to refractory nausea, vomiting, regurgitation, and, even, malnutrition, requiring revision of their bariatric operation. We report on the evaluation, diagnosis, and laparoscopic treatment of proximal obstructive symptoms secondary to a NASB. Methods From February 2005 to January 2009, we retrospectively reviewed the preoperative and perioperative data for 6 patients who had presented with proximal obstructive symptoms after undergoing banded Roux-en-Y gastric bypass. Results The mean interval from primary NASB placement to surgery was 58 months (range 25110). The mean duration of symptoms was 29 months (range 870). All patients presented with multiple symptoms, but all had nausea, vomiting, regurgitation, and dysphagia to liquids and solids. The patients had undergone multiple upper endoscopies (mean 4, range 36) and dilations (mean 1.3, range 12) without relief of their symptoms. All patients underwent successful laparoscopic removal of the NASB. Their mean hospital stay was 1 day (range 02). No operative or postoperative complications occurred. The reflux and obstructive symptoms had resolved immediately postoperatively in all patients. Conclusion Patients with a NASB in place can experience proximal obstructive symptoms. Endoscopy is deceptive in judging the stomal size, because the endoscope can be pushed through the band area. Moreover, endoscopic dilation will offer no benefit in most patients with symptomatic banded Roux-en-Y gastric bypass. Laparoscopic removal of the NASB is safe, relieves the symptoms immediately, and can be applied to patients who have undergone both open and laparoscopic Silastic banded bariatric procedures.

Original languageEnglish (US)
Pages (from-to)190-193
Number of pages4
JournalSurgery for Obesity and Related Diseases
Volume8
Issue number2
DOIs
StatePublished - Mar 1 2012

Keywords

  • Banded gastric bypass
  • Bariatric complications
  • Endoscopy
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery

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