The following are “Does” from the syllabus
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Gastric band deflation
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Removal of Gastric Band (open or laparoscopic) in emergency situations
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- Gastric band deflation
- Pillow behind lower back
- Lift head up
- Brace with fingers and insert Huber needle
- Huber needle is non-coring
- If can’t find, then use 25g fine bore
- This should take the the urgency out the situation
- Consult the bariatric surgeon
- Gastric band deflation
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- Removal of band - Generally lap
- First step is to remove all of fluid from band
- Trace the tubing from the subcutaneous port to the band
- Cut down over the capsule surrounding the band
- There may be gastro-gastric stitches that need to be removed
- Cut down onto buckle of band with diathermy
- Divide band and also cut the tubing and then remove it
- Subcutaneous port and remaining tubing then also needs to be removed
- Leave a drain
- ALWAYS – Keep all pieces of the band on a mayo table and reassemble to be sure entire band is removed
- Removal of band - Generally lap
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- Endoscopic removal (if majority of band is intraluminal and tubing disconnected):
- Requires band cutter and retrieval system
- Low morbidity if successful
- Subcutaneous port needs to be removed first and the tubing divided so the remaining tubing can be pulled into the stomach without tethering to the port
- Laparoscopic removal (most common approach):
- Mobilise adhesions and identify tubing
- Divide band and remove
- Fully eroded
- Gastrotomy
- Cut the band inside the stomach
- Close the Gastrotomy behind
- The stomach will have healed as the band eroded therefore no defect to close
- Partially eroded
- Cut down on to the adhesions and identify the band
- Cut the band
- May required gastric defect to be closed
- Consider endoscopy + leak test
- Drain placement if stomach wall repaired
- Open surgery (reserved for complex cases):
- Required for dense adhesions, severe sepsis, or inability to safely access band laparoscopically
- Endoscopic removal (if majority of band is intraluminal and tubing disconnected):