Gastric plication for repeated gastric band prolapse after endoscopic treatment: A case report

Background: The Band prolapse complications of laparoscopic adjustable gastric banding (LAGB) can be treated endoscopically. We present two patients with repeated prolapses after endoscopic treatment who required gastric plication treatments. Methods: From December 2007 to March 2016, 1469 consecutive patients (227 male, 1242 female) underwent LAGB; 56 patients had band prolapses and 16 patients were treated by endoscopy. Among the 16 patients, two cases that showed repeated prolapses could be repaired with gastric plication treatments. Results: The first case was of a 35-year-old woman underwent laparoscopic gastric plication due to repeated band prolapse. The second case was of a 43-year-old woman with a history of three episodes of band prolapse underwent gastric plication treatment. The clinical features are discussed. Conclusions: Gastric plication treatment of recurred band prolapse is an effective and feasible procedure. Introduction Laparoscopic adjustable gastric banding (LAGB) is a simple, safe and effective procedure for treating morbid obesity. However, several complications after LAGB have been reported, such as band erosion, prolapse, gastric perforation, abscess, tube disconnection, port flip down and infection. These complications could be the main cause of failure after LAGB. For this reason, revisional weight-loss surgery after failed LAGB might be considered [1]. Band prolapse is a significant and common late complication after LAGB [2]. We have performed endoscopic treatment of band prolapse as we reported [3]. However, band prolapse occurred repeatedly in two cases. We present two patients with repeated prolapses after endoscopic treatment who required gastric plication treatments. Case reports Case 1 A 35-year-old woman with BMI (body mass index) 40 underwent LAGB procedure to treat her obesity using the pars flaccida technique with no implication suture, and port placement under the anterior sheath of the rectus abdominis muscle (Figure 1). The patient presented a history of onset of band prolapse 22 months after the LAGB procedure (Figure 2). The symptoms of prolapse were sudden abdominal pain and repeated vomiting. An endoscopic procedure was performed after deflation of the band under intravenous anesthesia. Band prolapse was diagnosed and treated by endoscopy. After a prolapsed stomach pouch was found, we inflated it with air. The prolapsed stomach pouch was gradually reduced as the stomach was inflated with air. The stomach was fully reduced and finally the band returned to its normal position. After reduction, the entire lumen of the stomach was examined to check its normality (Figure 3). However, the patient had the second episode of band prolapse that required endoscopic treatment five months after the first one (Figure 4). We treated it with the same endoscopic technique as above (Figure 5). The patient had recurrence that was treated by the endoscopic Correspondence to: Kang SH, Department of Surgery, Seoul Surgical Hospital, 109 Joongdaero, Songpa-gu, Seoul 05718, South Korea, E-mail: [email protected]