The Swedish Laparoscopic Adjustable Gastric Banding for Morbid Obesity
Radiologic Findings in 218 Patients
K. J. Mortelé1,2,
P. Pattijn3,
P. Mollet1,
F. Berrevoet3,
U. Hesse3,
W. Ceelen3 and
P. R. Ros2
1
Department of Radiology, University Hospital Ghent, De Pintelaan 185, 9000
Ghent, Belgium.
2
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School,
75 Francis St., Boston, MA 02115.
3
Department of Surgery, University Hospital Ghent, 9000 Ghent, Belgium.
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Fig. 1. —Drawing shows surgical procedure. Band (arrow) is
looped around upper portion of stomach, thereby creating small upper pouch
that communicates through stoma with remainder of stomach. Sutures
(arrowheads) between serosa of stomach proximally and distally to
band are placed to maintain correct position of band.
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Fig. 2. —Abdominal radiograph obtained from 34-year-old woman shows
normal appearance of Swedish adjustable gastric banding system (SAG-BAND;
Obtech Medical, Baar, Switzerland) consisting of contrast medium-filled
inflatable inner cuff (white arrow), connecting silicone tube
(arrowhead), and subcutaneous sutured radiopaque access port
(black arrow).
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Fig. 3A. —Radiographs obtained from 20-year-old woman show results of
band adjustment. Barium-enhanced upper gastroesophageal radiograph before
adjustment shows mild narrowing of gastric lumen (arrows) at
presumptive position of nonradiopaque band.
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Fig. 3B. —Radiographs obtained from 20-year-old woman show results of
band adjustment. Barium-enhanced upper gastrointestinal radiograph after
adjustment (percutaneous injection of 5 mL isoosmolar contrast material into
access port) shows opacification of band, significant reduction in stoma size
(arrows), and retained oral contrast medium in upper pouch
(arrowheads).
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Fig. 4. —Misplaced band in 50-year-old man with insufficient weight
loss 4 weeks after band placement. Barium-enhanced upper gastrointestinal
radiograph reveals misplaced band. Note normal gastroesophageal junction with
projection of band (arrows) to left of stomach.
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Fig. 5. —Misplaced band in 45-year-old woman presenting with severe
vomiting. Barium-enhanced upper gastrointestinal radiograph obtained 2 days
after surgery shows incorrect positioning of opacified band (arrows)
around lower part of stomach.
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Fig. 6. —Severe band slippage in 40-year-old woman presenting with
insufficient weight loss, reflux disease for weeks, and progressive decrease
in ability to eat. Barium-enhanced upper gastrointestinal radiograph reveals
extreme pouch enlargement on left side (arrowheads), rotation of
band, and complete stoma obstruction (arrow).
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Fig. 7A. —Moderate band slippage in 42-year-old woman presenting with
insufficient weight loss and nocturnal regurgitation. Barium-enhanced upper
gastrointestinal radiograph shows pouch enlargement on left side
(arrows) and horizontal placement of band (arrowhead) but
passage of barium suspension through stoma.
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Fig. 7B. —Moderate band slippage in 42-year-old woman presenting with
insufficient weight loss and nocturnal regurgitation. Laterolateral radiograph
obtained after complete deflation of band reveals increased passage of
contrast medium through stoma but persistent posterior herniation
(arrows) of stomach.
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Fig. 8A. —Pouch enlargement in 41-year-old man with stabilization in
his weight loss curve and gastroesophageal reflux disease. Barium-enhanced
upper abdominal radiograph shows filiform passage of contrast medium at level
of stoma (arrow) and significant enlargement of upper gastric pouch
(arrowheads).
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Fig. 8B. —Pouch enlargement in 41-year-old man with stabilization in
his weight loss curve and gastroesophageal reflux disease. Barium-enhanced
upper abdominal radiograph obtained 4 weeks after deflation of band shows
normalization of volume of upper gastric pouch (arrows).
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Fig. 9A. —Rotation of the access port in asymptomatic 20-year-old
woman. Abdominal radiograph focused on access port in upright position shows
significant rotation of port (arrow).
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Fig. 9B. —Rotation of the access port in asymptomatic 20-year-old
woman. Subsequent radiograph taken of same patient in supine position shows
spontaneous derotation of port (arrow).
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Fig. 10. —Leakage of contrast medium in 23-year-old woman presenting
with insufficient decrease in ability to eat after first adjustment. Focused
abdominal radiograph reveals leakage of contrast medium (arrows)
alongside connecting tube.
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Fig. 11. —Leakage of contrast medium in 25-year-old woman with
insufficient decrease in ability to eat after first adjustment.
Barium-enhanced upper gastrointestinal radiograph obtained during second
adjustment session shows leakage of injected contrast medium at level of
gastric band (arrow).
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Fig. 12. —Food trapped in band found in 48-year-old woman presenting
with acute severe dysphagia and odynophagia immediately after eating.
Barium-enhanced upper gastrointestinal radiograph reveals presence of
intraluminal filling defect in stoma consistent with food entrapment
(arrows). Subsequent complete deflation of band allowed obstructing
food elements to pass.
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Copyright © 2001 by the American Roentgen Ray Society.
