Laparoscopic Repositioning of Heliogast® Gastric Band after Anterior Slippage

Background: Gastric slippage is a well-described complication of gastric banding. The Heliogast® band is equipped with a locking mechanism that enables its straightforward reopening and repositioning. Our experience with Heliogast® band salvage after anterior slippage is reported. Methods: The study sample comprised 418 consecutive patients who underwent 2-step laparoscopic gastric banding with the Lap-Band® first (n=235) followed with the Heliogast® band (n=183). Gastric slippage was diagnosed by symptoms of dysphagia and vomiting and was confirmed with Gastrografin® swallow. Patients who did not respond to conservative treatment were laparoscopically reoperated. In the Heliogast® group, the band was dissected free, unlocked, and repositioned. In the Lap-Band® group, when reopening proved impossible, the band was removed with or without replacement. Results: 10 patients (2.4%) underwent reoperation for anterior slippage, 5 with a Lap-Band® (2.1%) and 5 with a Heliogast® band (2.7%). Band repositioning was feasible in all 5 patients in the Heliogast® group, but in only one of the patients in the Lap-Band® group; in the others, the band was removed. Band repositioning was confirmed radiologically. No post-operative complications were recorded, and all patients were discharged on the first day after surgery. At a median 10 months' follow-up after Heliogast® repositioning, all patients had satisfactory weight loss. Conclusion: Laparoscopic Heliogast® band salvage after anterior slippage is comparatively simple and safe, with excellent postoperative results and no interference with continued weight loss. This constitutes an important means of management for the bariatric surgeon.