Gastric Banding - World Laparoscopy Hospital · 2 World Laparoscopy Hospital Essentials of...

Gastric Banding

R.K. Mishra

World Laparoscopy Hospital

World Laparoscopy Hospital Essentials of Laparoscopic Surgery

Definition

Gastric banding is a restrictive procedure

which creates an hourglass stomach,

with superior portion extremely limited

volume 15ml only.

Kuzmak in New Jersey developed first

adjustable gastric band.

Principle

Adjustable gastric band is placed

around the superior portion of the

stomach, near the esophageal hiatus,

leaving a 15 ml pouch

Indications

Bady mass index greater than 40

BMI 35 and 40 associated with severe

comorbidity

BMI = Weight in kg/height in m2

Click here to calculate BMI

Gastric Band

Dissection Principle

Anatomy

1. Gastrophrenic ligament

2. Loose areolar retrogastric tissue

3. Omental bursa

Retrogastric tunnel

Contraindication

BMI less than 35

Unable to tolerate G.A

Pregnancy

Severe mental illness

Relative contraindication:

Previous upper abdomen laparotomy

Hiatal Hernia

Patient Position

Position of surgical team

Access Technique

Port Position

Alternative Port Position

Port Alteration

Care for trocar

Task Analysis

Exposure

Retracting the liver

Exposure of Greater

Curvature

Where to start Dissection ?

Equator of balloon is the land mark to start Dissection

Introduction of Measuring

Creation of retro gastric tunnel

Start of Dissection

Dissection starts at Equator of

balloon

Dissection at Equator of

balloon

Gastrosplenic

Ligament is

dissected then plane

is created behind

caudal end of the

fundus of stomach

Danger entering mediastinum

Danger entering Omental

Finishing Dissection

Gastric Band

Preparing Band by flushing

Saline

Introduction of Band into

abdomen

Applying Band

Loose Closure of Band

Re inflation of balloon & Tight

closure

Fixation of Band

Procedure

Gastric Muff

Fixation of Reservoir

Post Operative Course

Band Calibration after 3 week

Band Calibration under

radiological control

Complications

Thank You

Certification Ceremony Batch November 2007

Gastric Banding - World Laparoscopy Hospital · 2 World Laparoscopy Hospital Essentials of...

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