Abstract
Introduction:
Non-adjustable gastric bands (NAGB) are a type of historical weight-loss surgery designed to help individuals with obesity achieve long-term weight management. 1,2 We present a case of a Molina NAGB which had eroded through the serosa of the stomach causing a gastric stricture.
Case Report:
74 year-old female with past medical history of depression and anxiety with a past surgical history of open cholecystectomy and open bariatric surgery that was performed in the 1980s. The patient was unaware of specific details of her bariatric procedure other than that it involved placement of a band. In January of 2024, she presented to the bariatric clinic complaining of nausea, vomiting, dysphagia, and left upper quadrant abdominal pain. She was not tolerating solid foods and only some liquid foods. Preoperative imaging did not reveal any staple lines to suggest a vertical band gastroplasty so we proceeded with the assumption that this was a nonadjustable gastric band. Her esophagoduodenoscopy was done at an outside hospital, so images were not available; however, the report stated a 3 cm gastric pouch with a traversable stoma, demonstrated no band erosion, no gastric-gastric fistula, and no esophagitis. Her symptoms, preoperative EGD findings, and imaging findings served as her indication for surgery. We were unable to acquire her prior operative note.
The patient was placed supine, prepped, and draped in the standard sterile fashion. Veress needle for entry was performed at Palmer’s point. Ports were placed in the left mid abdomen, left lateral abdomen, periumbilical, and right lateral abdomen. A lysis of adhesion was performed, and the patient was placed in steep reverse Trendelenburg before docking the robot. Adhesions from the liver to the abdominal wall and omentum to the liver were taken down to visualize the stomach. It was then found that the stomach was plastered to the liver, and tedious lysis of adhesions was performed to free the two organs. The proximal stomach was found to be extensively fibrotic. Careful dissection of the fibrosis revealed this to be associated with a wad of mesh. A dense fibrotic capsule was then found encasing the gastric band. EGD was performed, which showed stenosis that could accommodate the endoscope; no mesh was visualized intraluminally. The distal stomach and duodenum appeared normal. The freed portion of the band was then cut and used as a post to continue dissecting laterally; fortunately, with this dissection, the band came free and was removed in its entirety. The EGD was reinserted and revealed no gastric leak. A 56 French Maloney dilator was used for dilation of the stricture. The robotic instruments were removed, undocked, and port sites closed.
She was discharged on postoperative day 1 on a full liquid diet following 1 week of a soft diet. At the postoperative visit (2 weeks), she was advanced to regular food.
Conclusion:
Molina gastric bands that erode into the serosa of the stomach can be removed via a robotic approach and should be a consideration when deciding management of this complication.
Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
The patient has given us consent to share this video.
No competing financial interests exist.
Runtime of video:
6 min 40 sec.