Lap-Band insertion, calibration, and front fixation techniques

Lap-Band Placement and Calibration

Move the camera to the position of the puncture cannula 5, and guide the lap-band through the puncture cannula 5 to introduce it into the abdominal cavity.

Then, the lens is moved back to the puncture cannula 3, the end of the Lap-Band catheter is cut off, the cut surface is acute, and the last 4-6 cm of its length is inserted into the small hole at the tip of the placement device.

Move the placement device along its channel toward the small bend and remove the strap tube from the small hole.

Remove the placer.

Pull the strap guide until the strap is in the correct position, then fasten the buckle.

The calibration tube is placed in the stomach, 25 ml of air is injected into the balloon, and then the anesthesiologist pulls the calibration tube outward until the balloon compresses the esophagogastric junction.

Please check that the strap may be located at the balloon.

Remove the air from the calibration tube and try fastening the buckle on the strap.

Estimate whether the fully buckled straps are too tight.

If it appears too tight, it is recommended to separate the small omental fat within the bandage loop.

If it is not tight, use a closing tool to tighten the buckle completely.

The ligation catheter is pulled out of the abdominal cavity through the puncture cannula 6 to expose the front of the ligation for fixation.

front fixed

It is necessary to sew and secure the bandage in front of it. This will keep the bandage in a high position in the stomach and firmly fix other parts of the stomach to prevent them from slipping above the bandage.

Insert the suture (Ethibond 2-0 suture with a 26mm needle) through the trocar 5, and then insert the grasping forceps through the trocar to select and grasp the stomach wall below and above the bandage to be sutured.

The first stitch should be close to the greater curvature of the stomach, not on the greater curvature itself. Every stitch should be a precise suture from stomach wall to stomach wall.

Usually, three stitches are sewn, but sometimes four stitches are needed.

Avoid suturing too close to the buckle to prevent the hard, irregular buckle from rubbing against the stomach wall and causing erosion.

Then the ligature catheter was pulled back into the abdominal cavity and pulled out from the puncture cannula 5.

Discontinue pneumoperitoneum, release as much CO₂ as possible, and then remove the trocar.

Burial of water injection pump

Extend the skin incision at the 5 puncture sites to 4 cm, separate the subcutaneous fat, and expose the anterior sheath of the rectus abdominis muscle.

Four 2-0 Prolene threads were implanted in a square, with each pair spaced approximately 1 cm apart.

Trim the end of the tubing neatly and connect it to the metal connector of the water pump.

Insert the Prolene suture into the injection pump, insert the ligature back into the abdominal cavity, and secure the injection pump in the appropriate position to ensure that the ligature enters the abdominal cavity directly and smoothly.

Postoperative follow-up and adjustment

To ensure that Lap-Band surgery achieves satisfactory weight loss results, postoperative follow-up, including band adjustment, is just as important as the surgery itself. Therefore, good follow-up and adjustment techniques are essential.

Comprehensive follow-up can establish a database, making it easy to monitor the follow-up process of each patient and to detect loss to follow-up as early as possible, so as to re-establish contact with patients.

A comprehensive yet concise database system will be discussed in later chapters.

The strap adjustment guidelines we typically use are shown in Table 20.1-2.

If a 10cm bandage is placed along the lesser omentum relaxation area using our standard method, 1ml of normal saline will be injected for the first time 5 weeks post-surgery.

Subsequent water injection methods are based on the principles in Table 20.1-2, typically injecting 0.3 to 0.5 ml of water each time.

If using the new 11cm strap (Vanguard), we initially fill it with 2.5ml of water, then add 1ml each time we adjust it until we feel a noticeable binding sensation, and then 0.5ml each time.

Any weight loss surgery requires lifelong follow-up.

Initially, we followed up every 2 to 4 weeks, and then gradually extended the interval, but the longest interval could not exceed 12 months.

The amount of water in the bandage can be adjusted based on clinical or imaging standards.

Due to cost and limitations in medical services, we did not use imaging methods.

For more information, please refer to reports by Favretti et al.

The level of adjustment of the straps should be sufficient to maintain a sustained feeling of fullness in the patient.

Weight loss should be gradual. In the early stages, the ideal rate of weight loss is more than 0.5 kg but less than 1 kg per week.

Adjustments should be made in a way that does not cause restrictive symptoms, such as heartburn, vomiting, discomfort, or difficulty eating regular foods.

Weight loss should be planned to be achieved gradually over 18 months to 3 years, depending on the initial weight.

When weight loss is ineffective, the feeling of fullness after meals disappears quickly, the patient's food intake increases at each meal, or there is hunger between meals, we will consider increasing the amount of water injected.

We will consider draining fluid when a patient experiences vomiting, heartburn, regurgitation, coughing, wheezing and choking (especially at night), inability to eat a variety of foods, or difficulty adapting to dietary habits.

We do not adjust the amount of water when the patient's food intake is reasonable, the weight loss rate is appropriate, and there are no adverse symptoms.

in conclusion

The placement of Lap-Bands and postoperative patient follow-up are generally not complicated, and significant and lasting weight loss, as well as improvements in health and quality of life, can be achieved safely and gradually.

There are many details that are crucial, such as receiving good surgical training, maintaining long-term contact with patients, and attending continuing education courses, which help to continuously improve surgical outcomes.

When good surgical and follow-up skills are available, treating these patients is one of the most meaningful parts of clinical practice.