gastric banding - world laparoscopy hospital · 2 world laparoscopy hospital essentials of...

Gastric Banding

R.K. Mishra

World Laparoscopy Hospital

2

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.

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Principle

Adjustable gastric band is placed

around the superior portion of the

stomach, near the esophageal hiatus,

leaving a 15 ml pouch

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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

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Gastric Band

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Dissection Principle

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Anatomy

1. Gastrophrenic ligament

2. Loose areolar retrogastric tissue

3. Omental bursa

Retrogastric tunnel

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Contraindication

BMI less than 35

Unable to tolerate G.A

Pregnancy

Severe mental illness

Relative contraindication:

Previous upper abdomen laparotomy

Hiatal Hernia

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Patient Position

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Position of surgical team

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Access Technique

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Access Technique

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Access Technique

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Port Position

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Alternative Port Position

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Alternative Port Position

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Port Alteration

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Care for trocar

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Task Analysis

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Exposure

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Exposure

Retracting the liver

Exposure of Greater

Curvature

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Where to start Dissection ?

Equator of balloon is the land mark to start Dissection

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Introduction of Measuring

Probe

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Creation of retro gastric tunnel

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Start of Dissection

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Dissection starts at Equator of

balloon

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Dissection at Equator of

balloon

Gastrosplenic

Ligament is

dissected then plane

is created behind

caudal end of the

fundus of stomach

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Danger entering mediastinum

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Danger entering Omental

bursa

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Finishing Dissection

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Gastric Band

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Preparing Band by flushing

Saline

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Introduction of Band into

abdomen

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Applying Band

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Loose Closure of Band

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Re inflation of balloon & Tight

closure

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Fixation of Band

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Procedure

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Gastric Muff

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Fixation of Reservoir

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Post Operative Course

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Band Calibration after 3 week

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Band Calibration under

radiological control

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Complications

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Thank You

Certification Ceremony Batch November 2007

gastric banding - world laparoscopy hospital · 2 world laparoscopy hospital essentials of...

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