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INDICATIONS

If a patient meets approved guidelines, then the surgeon may select the use of a gastric band to restrict gastric size. The procedure is much less commonly performed than the Roux-en-Y gastric bypass or the gastric sleeve. Many of the same selection criteria used for the Roux-en-Y gastric bypass and gastric sleeve apply.

PREOPERATIVE PREPARATION

Preoperative preparation and anesthetic considerations are similar to those for gastric bypass.

OPERATIVE PREPARATION

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. Then a time-out is performed.

POSITIONING

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.

INCISION AND DETAILS OF THE OPERATION

Port placement is similar to that for 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 Trendelenburg position. The gastroesophageal 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 gastroesophageal 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 the anesthesiologist is removed, and a calibration balloon is inserted and inflated with 15 mL of saline. The band is placed into the abdomen using an insertion device (FIGURES 5 and FIGURE 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 angle of His to the previously made opening in the soft tissue along the lesser curvature (FIGURE 7). The band is placed around the stomach just below the intragastric balloon (FIGURE 8). The balloon is deflated, and the band is buckled close (FIGURE 9). The orogastric sizing balloon is removed. The final position of the band is shown in FIGURE 9. Several interrupted nonabsorbable sutures (2-0) are used to imbricate the stomach over the band in order to prevent slippage (FIGURE 10). The distal tubing is retrieved through a left paramedian incision at the 15-mm port site (FIGURE 2). A subcutaneous pocket is made for ...

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