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Access-port fixation on the left pectoral fascia in laparoscopic adjustable gastric banding.

van Wageningen B, Aarts EO, Janssen IM, Berends FJ - Obes Surg (2011)

Bottom Line: Arch.Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results.In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. b.vanwageningen@chir.umcn.nl

ABSTRACT
Access-port (AP) complications after laparoscopic adjustable gastric banding (LAGB) are often seen but seldom reported in literature. AP complications requiring additional surgery is reported in 3.6% to 24% of LAGB patients (Susmallian et al. Obes. Surg, 4:128-131, 2003; Peterli et al. Obes. Surg., 12(6):851-856, 2002; Busetto et al. Obes. Surg., 12:83-92, 2002; Mittermair et al. Obes. Surg., 19:446-450, 2009; Holeczy et al. Obes. Surg., 9:453-455, 1999; Bueter et al. Arch. Surg., 393:199-205, 2008; Launay-Savary et al. Obes Surg, 18:1406-1410, 2008; Balsiger et al. J. Gastrointest. Surg., 11:1470-1477, 2007; Szold and Abu-Abeid Surg. Endosc., 16:230-233, 2002). We evaluated the effect of fixing the AP on the pectoral fascia using the Velocity™ Injection Port on complication and re-operation rate. From January 2005 till October 2007, 619 LAGB procedures were performed using the SAGB QuickClose™. All procedures were performed by three dedicated surgeons using the pars flaccida technique. APs were placed on the fascia of the pectoral muscle using an infra-mammary incision. The AP device was fixed on the fascia using the Velocity™ Injection Port and Applier. Data was obtained retrospectively and records of 619 consecutive patients were reviewed for access-port complications. Sixty-eight AP complications were observed. Complications could be divided in four categories. Discomfort was reported in 30 patients, seven needing additional surgery. Infection contributed to 11 patients needing surgical removal of the device. Fourteen Patients with superficial infection were treated conservatively. Nine patients had inaccessible APs. Ultrasound-guided access was required in three patients. The remainder needed surgical relocation of the AP. Leakage of the tube was observed in four patients all of which needed revisional surgery. Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results. In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.

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Related in: MedlinePlus

a Infra-mammary incision facilitating the AP place. b Tunnelling of the tube in order to reduce wear and tear of the tube. c Placement of the AP device on the pectoral fascia. d Cosmetic result at termination of the LAGB procedure
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Fig1: a Infra-mammary incision facilitating the AP place. b Tunnelling of the tube in order to reduce wear and tear of the tube. c Placement of the AP device on the pectoral fascia. d Cosmetic result at termination of the LAGB procedure

Mentions: All LAGB devices were placed using a standard five-port laparoscopic technique as described by Belachew [18, 19] and positioned using the pars flaccida technique. In order to gain access to the pectoral fascia, the sub-xiphoid incision was made just left of the midline and extended laterally to approximately 3 cm in the infra-mammary fold. Blunt and electrocautery dissection was performed to create a pocket large enough to fit the AP (see Fig. 1a–d). The AP was then connected to the tube. Fixation of the AP on the pectoral fascia was obtained using the four retractable hooks of the Velocity™. Data was statistically analysed using SPSS 16.0®. All data is reported as mean ± 95% confidence interval (95%CI). Patients with less than 6 months of post-operative follow-up were contacted by telephone and/or by mail.Fig. 1


Access-port fixation on the left pectoral fascia in laparoscopic adjustable gastric banding.

van Wageningen B, Aarts EO, Janssen IM, Berends FJ - Obes Surg (2011)

a Infra-mammary incision facilitating the AP place. b Tunnelling of the tube in order to reduce wear and tear of the tube. c Placement of the AP device on the pectoral fascia. d Cosmetic result at termination of the LAGB procedure
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3040804&req=5

Fig1: a Infra-mammary incision facilitating the AP place. b Tunnelling of the tube in order to reduce wear and tear of the tube. c Placement of the AP device on the pectoral fascia. d Cosmetic result at termination of the LAGB procedure
Mentions: All LAGB devices were placed using a standard five-port laparoscopic technique as described by Belachew [18, 19] and positioned using the pars flaccida technique. In order to gain access to the pectoral fascia, the sub-xiphoid incision was made just left of the midline and extended laterally to approximately 3 cm in the infra-mammary fold. Blunt and electrocautery dissection was performed to create a pocket large enough to fit the AP (see Fig. 1a–d). The AP was then connected to the tube. Fixation of the AP on the pectoral fascia was obtained using the four retractable hooks of the Velocity™. Data was statistically analysed using SPSS 16.0®. All data is reported as mean ± 95% confidence interval (95%CI). Patients with less than 6 months of post-operative follow-up were contacted by telephone and/or by mail.Fig. 1

Bottom Line: Arch.Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results.In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. b.vanwageningen@chir.umcn.nl

ABSTRACT
Access-port (AP) complications after laparoscopic adjustable gastric banding (LAGB) are often seen but seldom reported in literature. AP complications requiring additional surgery is reported in 3.6% to 24% of LAGB patients (Susmallian et al. Obes. Surg, 4:128-131, 2003; Peterli et al. Obes. Surg., 12(6):851-856, 2002; Busetto et al. Obes. Surg., 12:83-92, 2002; Mittermair et al. Obes. Surg., 19:446-450, 2009; Holeczy et al. Obes. Surg., 9:453-455, 1999; Bueter et al. Arch. Surg., 393:199-205, 2008; Launay-Savary et al. Obes Surg, 18:1406-1410, 2008; Balsiger et al. J. Gastrointest. Surg., 11:1470-1477, 2007; Szold and Abu-Abeid Surg. Endosc., 16:230-233, 2002). We evaluated the effect of fixing the AP on the pectoral fascia using the Velocity™ Injection Port on complication and re-operation rate. From January 2005 till October 2007, 619 LAGB procedures were performed using the SAGB QuickClose™. All procedures were performed by three dedicated surgeons using the pars flaccida technique. APs were placed on the fascia of the pectoral muscle using an infra-mammary incision. The AP device was fixed on the fascia using the Velocity™ Injection Port and Applier. Data was obtained retrospectively and records of 619 consecutive patients were reviewed for access-port complications. Sixty-eight AP complications were observed. Complications could be divided in four categories. Discomfort was reported in 30 patients, seven needing additional surgery. Infection contributed to 11 patients needing surgical removal of the device. Fourteen Patients with superficial infection were treated conservatively. Nine patients had inaccessible APs. Ultrasound-guided access was required in three patients. The remainder needed surgical relocation of the AP. Leakage of the tube was observed in four patients all of which needed revisional surgery. Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results. In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.

Show MeSH
Related in: MedlinePlus