++
++
++
++
++
++
++
++
++
++
++
++
A surgeon may select the use of a gastric band to restrict the gastric size. The same selection criteria used for the Roux-en-Y gastric bypass apply.
++
Preoperative preparation and anesthetic considerations are similar to the gastric bypass.
++
Prophylactic antibiotics and venous thromboembolism prophylaxis are employed. A Foley catheter is not inserted into the bladder because of the short duration of the procedure.
++
The patient is positioned in a modified lithotomy position. The surgeon is positioned between the legs and the assistant to the patient's left. The room setup is shown in Figure 1.
++
The port placement is similar to that of a Roux-en-Y gastric bypass, with the exception of a left subcostal 15-mm port that is used to introduce the gastric band (Figure 2). Fewer ports may be used in some patients. The patient is placed in the reverse Trendelenberg position. The GE junction is exposed by retracting the liver proximally (Figure 3). Blunt dissection is used to create a retrogastric tunnel as shown in (Figure 4). Retraction of the stomach inferiorly facilitates exposure of the greater curve side of the GE junction. The retrogastric dissection is minimal and the goal should be to create a narrow tunnel that will act to prevent slippage of the device. The tunnel is created superior to the left gastric artery. The orogastric tube placed by anesthesia is removed and a calibration balloon inserted and inflated with 15 mL of saline. The band is placed into the abdomen using an insertion device (Figures 5 and 6). It is placed through a 15-mm port or passed directly through the abdominal wall (Figure 6). An atraumatic grasper is used to advance the gastric band from the opening along the greater curvature near the ...