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Invited Commentary |

Band Erosion in Patients Who Have Undergone Vertical Banded Gastroplasty—Invited Commentary

Lloyd D. MacLean, MD
Arch Surg. 1998;133(2):193. doi:10.1001/archsurg.133.2.193.
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This is a retrospective study of 250 obese patients operated on consecutively during an 8-year period using vertical banded gastroplasty with a 10- to 15-mL pouch and a 5-cm band of expanded polytef (also known as PTFE) (Gortex, WL Gore and Associates Inc, Flagstaff, Ariz). An erosion of the band into the stomach developed in 7 (2.8%) of these patients; all 7 patients experienced excessive weight loss and symptoms of partial obstruction. The cause of erosion was probably a tight band in all patients, and the erosion was hastened by forceful endoscopy in 2 patients. Excision of the eroded band and adjacent inflamed stomach with reformation of a new pouch and Roux-en-Y reconstruction is an attractive solution to this problem. I find reinsertion of another band in a contaminated field less attractive, but the authors used this method only with lateral erosion. The idea of using the Salmon technique1 to avoid restapling an open staple line is also a useful method to consider in that special circumstance of lateral band erosion and staple-line dehiscence. The removal of the band by endoscopy or by gastrostomy (as done in patient 1) is not satisfactory, as the authors emphasize. In one of their patients in whom an erosion developed, as determined by endoscopy, the band was later not visible. This, in our experience, means that the band has eroded into the lumen of the stomach and has been passed. The late result in this setting is unacceptable weight gain. Late follow-up (5-year) data on how closely weight approximates normal values (data not provided) and information on eating habits will be of interest.

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