Transgastric endoscopic rendezvous technique for removal of eroded Molina gastric band.
Overview
abstract
The application of the nonadjustable gastric band (NAGB) for the treatment of morbid obesity was common in the 1980s. However, it was associated with an unacceptable reoperative rate and numerous postoperative complications such as gastric erosion. Removing an eroded NAGB is fraught with difficulty secondary to the extensive inflammatory response around the proximal stomach and left lobe of the liver. To circumvent these difficulties, we have devised a transgastric endoscopic rendezvous (TGER) technique for the removal of eroded Molina NAGBs. A case series of 2 patients who had undergone the TGER technique for removal of an eroded Molina NAGB was undertaken. The outcomes assessed included preoperative morbidity, a description of the surgical procedure, and the postoperative course. Both patients presented with symptoms consistent with proximal gastric outlet obstruction. The TGER technique was effectively applied in removing the eroded NAGB in both patients with no intraoperative, perioperative, or postoperative complications at 6 months of follow-up. One patient requested additional treatment for morbid obesity and subsequently underwent successful placement of an adjustable gastric band. Our small series has demonstrated that the TGER technique is a safe and effective procedure applicable to the complicated case of an eroded NAGB. The use of a combined endoscopic/transgastric approach facilitates complete avoidance of the thick adhesion surrounding the previously banded stomach with the capability of securing a gastrotomy in virgin tissue rather than opening and then closing the dense perigastric pseudocapsule. Nevertheless, the true utility of the TGER technique is soundly dependent on the availability of adequate resources and experienced surgical assistance and needs to be explored further.
