The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus

Background: Pouch development is a potentially serious problem following gastric banding, and reoperation is often demanded to maintain long-term function of the lap band. Laparoscopic gastric banding was performed with two different calibrations of the pouch. Within a period of 12 months, postoperative pouch behavior with regard to volume and shape was evaluated retrospectively, as were changes in the distal esophagus. Methods: The pouches of 14 patients with intraperitoneal band positioning were calibrated at 25 ml. The volumes of 54 patients operated by a suprabursal technique were set at 15 ml. We performed three radiological examinations and calculated the volumes using the ellipsoid formula d1 x d2 x d3 x pi /6. Four morphologically different pouch types have been observed: regular, concentric, eccentric-medial and eccentric-lateral. The phi -angle corresponds to the angle between the spinal column and the gastric band. Results: In the first group, the pouch volume increased from 21.2 ml +/- 21.2 to 87.9 ml +/- 64.6 (p=0.006) and the BMI fell from 47.1 kg/m(2) +/- 8.4 to 38.1 kg/m(2) +/- 7.0 (p=0.001). The pouch volume of the second group increased from 10.4 ml +/- 5.8 to 38.8 ml +/- 29.1 (p<0.001), and the BMI reduced from 48.4 kg/m(2) +/- 6.9 to 39.3 kg/m(2) +/- 6.7 (p<0.001). If the phi -angle is smaller than 4 degrees, the pouch is of the eccentric-medial type. Conclusions: The transbursal operative technique is responsible for the development of the eccentric-medial pouch. If the anterior sero-muscular fixative sutures tear, an eccentric-lateral pouch results. All pouch types are affected by changes at the pouch-esophageal junction and by pathological developments in the distal and middle oesophagus.