Novel Techniques, Same Complications: Slippage and Erosion of a MiniMizer Band after Banded Laparoscopic Roux-En-Y Gastric Bypass

Abstract

Persisting or recurring morbid obesity after standard Roux-enY gastric bypass (RYGB) remains a stumbling block in bariatric surgery. To this end, new surgical techniques and variations on the RYGB-theme have gained interest over the years. These include revising or narrowing the pouch, additional non-adjustable band placement or lengthening the biliopancreatic limb, be it during the primary or a revisional procedure [1]. Banding of the pouch using a silastic ring or a MiniMizer ring is said to prevent dilatation of the pouch, furthering restriction and thus aiding in weight loss or preventing weight regain. Another potential benefit that is put forward is the incidence reduction of dumping syndrome by preventing rapid emptying of the pouch [2]. Besides the advantages that a banded laparoscopic Roux-en-Y gastric bypass (B-RYGB) might offer, it seems that it suffers the same disadvantages that are well-documented in the laparoscopic adjustable gastric banding (LAGB). Food intolerance, band erosion, slippage, and small bowel obstruction have been described for both the B-RYGB and the LAGB [3]. In banding the gastric pouch, however, the question arises as to whether such a comparable technique will also produce similar complications as seen in the LAGB. In this aspect, we would like to present the case of a patient where slipping and erosion of the non-adjustable gastric band went hand in hand with the small bowel obstruction, causing overt food intolerance. The most notable aspect of this case is that all complications of a band were present at the same time. Case Report