Disappointing results with a 5 cm calibrating device for laparoscopic vertical banded gastroplasty.

BACKGROUND: The gastric outlet represents a critical point of laparoscopic vertical banded gastroplasty (LVBG): the diameter and the material used to calibrate the gastric outlet are essential for long-term success. We present the results of our initial clinical experience with the Proring band, a new calibrating device specifically designed to calibrate LVBG outlet. METHODS: Between February and April 2004, 13 LVBG were performed using the Proring band. There were 12 women and one man; their mean age was 44 years; mean preoperative weight was 118.8 kg; mean body mass index (BMI) was 44.4 kg/m(2). RESULTS: The immediate postoperative course was uneventful in all cases. In the follow-up 10 patients out of 13 (76.9%) presented a sudden or progressive food intolerance. Five patients were immediately reoperated by laparoscopic approach and five underwent endoscopic dilatation with initial clinical improvement; early recurrence of symptoms despite further dilatations occurred in four out of five cases. These four patients were then reoperated. Therefore a total of nine (69.2%) patients underwent a laparoscopic reoperation with Proring band removal and its replacement with a polypropylene band. In seven cases an intraoperative endoscopic dilatation was associated with the laparoscopic procedure. Outcome was successful in all cases, with discharge after two days. CONCLUSION: The results of our experience using the Proring band are unsatisfactory, showing 76.9% with outlet stenosis and 69.2% with reoperations. These data compare negatively with our previous experience on more than 900 VBG procedures using polypropylene mesh.