Evolution of gastric band implantation and port fixation techniques.

BACKGROUND: Laparoscopic adjustable banding (LAGB) has been shown to be an effective bariatric procedure with low postoperative morbidity and mortality. Long-term complications of the operation, including gastric and esophageal dilation, gastric prolapse, erosion, and port and tubing problems, may be, in part, the result of LAGB implantation technique and the long-term follow-up program. Band technology and implantation technique are in ongoing development to improve the long-term safety and efficacy of gastric banding. The evolution of gastric band implantation technique has included the perigastric and pars flaccida dissections and the so-called "2-step," a combination of the procedures. For the majority of anatomic circumstances, the pars flaccida approach has been shown to be most efficient and reduces the incidence and severity of long-term LAGB complications, while the 2-step is a valuable option in patients with excessive perigastric and visceral fat. Recently, mechanical port fixation, an alternative to suture fixation, has been introduced with good early results. METHODS: The perigastric and 2-step techniques are summarized, and detailed descriptions of the essential steps and caveats of the pars flaccida approach and mechanical port fixation are provided. CONCLUSION: LAGB has been associated with complications that are lessened in incidence and severity by use of the pars flaccida technique and mechanical port fixation.