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Optimization of access-port placement for the lap-band system.

Abstract：

BACKGROUND:The technical aspects of access-port (AP) placement are not generally described in Lap-Band series. METHODS:From November 2000 to April 2002, we performed Lap-Band procedures laparoscopically on 180 patients. A retrospective review was conducted of 3 consecutive AP-placement techniques in nonselected and demographically identical groups. In Group A (n=48, Nov. 2000 to July 2001), the AP was placed at the left subcostal margin. In Group B (n=23, Aug. 2001 to Sept. 2001), the AP was tunneled over the subcostal fascia towards the subxiphoid area. In Group C (n=109, Oct. 2001 to Apr. 2002), the AP tubing was tunneled over the subcostal fascia and connected to the AP, which was inserted through a 3-cm subxiphoid incision. RESULTS:AP-related problems occurred within the first few months following surgery. In Group A, 24 of the APs (50%) were tilted, and 14 (29%) were completely flipped over. 11 APs (23%) were found to be broken. 19 patients (40%) underwent an additional AP-related procedure. In group B, 12 APs (52%) were tilted and 1 patient required surgery to turn the AP. In Group C, 8 APs (7%) were turned slightly. 1 AP was found to be broken and required surgery to replace it. In this group, all APs were accessible for adjustment in the office. CONCLUSIONS:Tunneling the AP along the left subcostal area is an important technique to protect the AP system from breakage, by changing AP-tube position from vertical to horizontal in relation to abdominal wall movement. This technique also keeps the AP-tube connection over the fascia and protects it from "wear and tear" forces. The addition of fixation at the subxiphoid location helps maintain a straight orientation of the AP for easier adjustments.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

Spivak H,Gold D,Guerrero C

doi

10.1381/096089203322618759

subject

Has Abstract

pub_date

2003-12-01 00:00:00

pages

909-12

issue

6

eissn

0960-8923

issn

1708-0428

journal_volume

13

pub_type

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