Slippage after Adjustable Gastric Banding according to the Pars Flaccida and the Perigastric Approach

Objective: To evaluate laparoscopic adjustable gastric banding and the ‘pars flaccida’ techniques for treating morbidly obese patients. Subjects and Methods: Between May 1999 and July 2002, 64 patients underwent laparoscopic adjustable gastric banding. The ‘perigastric’ technique was performed in the first 31 patients. From September 2000 the band was positioned according to the ‘pars flaccida’ technique in the remaining 33 patients. The patients were divided into three groups: group 1 – ‘perigastric’ technique using Lap-Band size 9.75 and 10 cm (31 patients); group 2 – ‘pars flaccida’ technique using Lap-Band size 10 cm (12 patients), and group 3 – ‘pars flaccida’ technique using the Swedish band (21 patients). There were 58 females and 6 males with a mean age of 36.6 years (range 17–56). The preoperative mean body mass index was 46.2 kg/m2. Results: Band slippage occurred in 10/31 patients (32.2%) of group 1, 3/12 patients (25%) of group 2 and none in group 3 patients (p 0.01). Conclusion: The ‘pars flaccida’ technique significantly reduces the incidence of postoperative slippage after gastric banding. This complication is further reduced in the Swedish band group. Furthermore, we do not recommend using the 10-cm Lap-Band in the ‘pars flaccida’ technique.