Prevention of complications

PREVENTION OF COMPLICATIONS

Prevention of vomiting

Vomiting is entirely avoidable for many patients by following some simple rules:

  • Eat slowly
  • Chew well for 30 seconds
  • Wait 30 seconds between each mouthful
  • Mouthfuls should not be larger than the diameter of the inflated band
  • Do not eat and drink at the same time

If the patient continues to vomit (> 1 to 3 times /week) despite following these rules, moderate deflation of the band should be performed in radiology by the surgeon who knows the patient best.

The large majority of patients do not vomit or do so rarely, meaning that the band procedure is well tolerated and leads to very few complications.

Prevention of gastro-oesophageal reflux

A difference is made between :

Pre-operative reflux

Reflux corrected pre-operatively with a hiatus hernia anti-reflux surgical procedure. Weight loss alone usually corrects the reflux in the majority of cases.

Post-operative reflux

If the patient suffers from reflux or vomiting:

  • Reapply nutritional measures
  • Take anti-secretory medication for at least 3 days

If these measures are not sufficient:

  • Inform the surgeon rapidly
  • The surgeon will determine if the nutritional measures are being properly followed
  • If not, the surgeon may decide to deflate the band to help the passage of food

Under no circumstances should patients delay informing the surgeon for several weeks or months as complications may arise.

Prevention of oesophageal dilatation

To avoid this rare and entirely avoidable complication:

  • Inform the surgeon in the event of frequent vomiting (> 3 times / week) despite following eating rules
  • Consult the surgeon at least once a year to determine reinflation of the band (which tends to inflate itself due to osmosis) in order to avoid the complications of an overly inflated band.

Considerable vomiting will lead to reflux that will tighten the band from the inside due to the reactional inflation of the oesophageal mucus membrane.

This dilatation can be avoided and is usually reversible as most of the time, simply deflating the band will cause the dilatation to disappear.

Dr Jean-Yves Le Goff has never encountered enlargement of the oesophagus in his procedures.

It is essential to follow the dietary rules as they are a reflection of the patient’s good mental state.

Prevention of dilatation of gastric sack

This is a rare and entirely avoidable complication.

The Le Goff Technique surgically prevents this risk by fixing the band solidly so that it does not slip. The band is solidly fixed with:

  • Dissection at the edge of the stomach
  • A plicature which fixes the band with a gastric valve
  • Solid sutures after removing the fat in the oesophagus

Importance of post-operative prevention of vomiting

In some rare cases, despite following dietary rules and deflation up to total deflation, the dilatation of the gastric sack does not disappear.

A repeat operation may then be required to reposition the band above the dilatation and redoing the plicature (13 cases in 19 years of experience).

Prevention of gastric erosion

Gastric erosion may be diagnosed with a surgical procedure that is ineffective in weight loss and best identified by an x-ray.

In all cases, gastric erosion requires ablation of the band.

This is a rare but serious complication as it requires ablation of the band. Despite everything, the surgical procedure enables these rare patients to continue to eat in lesser quantities (anatomic fibre band) and so maintain acceptable excess weight loss.