Novel Method for Port Implantation in Lap-Band Surgery-Transumbilical Subfascial Port Implantation

Abstract

Background: Some patients who have undergone a laparoscopic adjustable gastric band operation express dissatisfaction with visible scars or protrusion of the access port after sufficient weight loss. We hypothesized that subfascial port implantation could minimize those problems as well as port-related complications. Subjects and Methods: We retrospectively reviewed the medical records of patients who underwent "transumbilical" subfascial port (SP) implantation between March 2009 and July 2011. We compared these results with those of conventional placement of laparoscopic adjustable gastric band ports (CP) on the anterior rectus fascia by the four-point suture technique. The SP technique rendered the access port essentially nonpalpable, and therefore it could only be accessed under fluoroscopy. Results: In total, 66 consecutive patients were enrolled into our study. Thirty-three patients underwent the SP procedure, and 33 patients underwent the CP procedure. Both groups were matched for age (31.4 +/- 6.5 years versus 34.0 +/- 8.7 years, P=.168), gender (female: male 30:3 versus 27:6, P=.282), and preoperative body mass index (36.6 +/- 5.4 kg/m(2) versus 36.9 +/- 4.1 kg/m(2), P=.786). The mean follow-up period was 9.6 +/- 3.9 months for the SP group and 18.9 +/- 5.3 months for the CP group. During that period, the SP group tended to have a lower incidence of port infection (SP group, 0/33; CP group, 3/33, P=.076), and no patients in the SP group complained of hypertrophic scarring at the port site (SP group, 0/33; CP group, 4/33; P=.04). Two patients in the CP group had port inversion/migration. Two patients in the CP group had port protrusion. Two patients in the CP group underwent port revision surgery (subfascial port) 6 months after port removal. One patient in the CP group underwent port exchange surgery under local anesthesia for port leakage. None of the patients in the SP group had any of the above port-related complications. Conclusions: Our preliminary results show that subfascial implantation of the laparoscopic adjustable gastric band port could minimize port-related complications during the weight loss phase.