Laparoscopic Gastric Banding Can Interfere with Adequate Plication during Post-Bariatric Abdominoplasty

Introduction: Laparoscopic gastric banding (LGB) is an effective bariatric procedure.  Bariatric patients often require post-operative body contouring which involves plication of the rectus fascia. Difficulties in performing such plication due to the presence of the port and its tubing system have not been well described in the literature.

Objectives: Assess the incidence of LGB hindering adequate plication of the rectus fascia in post-bariatric patients. Describe various techniques in order to minimize interference from port.

Methods:Patients who previously underwent LGB and subsequently post-bariatric abdominoplasty between 2005 and 2013 were included. Retrospective review of demographic data, operative procedures, and follow up information was performed.

Results: During the time period 178 patients underwent post-bariatric abdominoplasty, 19 (10.7%) patients had LGB. The average age of the patients with LGB was 39.8 (17-67) years old, 4 male and 15 female.  Two of the patients with LGB underwent repositioning of the port system. Repositioning was performed by the bariatric surgeon and relocated in the right upper quadrant of the abdomen.  We were able to perform a complete abdominal wall plication in five (26.3%) LGB patients.  13 (68.4%) patients had a partial plication.  Three (15.8%) patients presented with postoperative fullness in the epigastrium.  Postoperative complications such as seroma, wound dehiscence or hematoma were not observed.

Conclusions: LGB is an effective treatment of morbid obesity; however, the location of the port system can interfere with adequate plication of the rectus fascia during abdominoplasty.