Management:

1.     Laparoscopic removal : divide adhesions, use tubing to get to band, cut and remove. This will leave a hole. You can use an omental patch for closure?

2.     Transgastric approach: use a separate gastrostomy on the greater curve, find the band near the fundus, divide it and remove it. The gastrostomy can then be closed with a linear stapler. The smaller hole where some of the band and tubing would have been showing at the top can be left alone. The key here is that the encapsulation of the band has stopped sepsis and therefore you do not disrupt this area.

An alternative is to create a small gastrostomy for a laparoscopic balloon port to enter the stomach. With an endoscope to visualise and scissors through the port, the band can be cut on the inside of the stomach. Snare can then be used to retrieve the port, or it can be removed through the lap port (ideally 15mm)

3.     Endoscopic removal – using an ERCP tools, you can pass a JAG wire around the band, then a stone crusher which can break through the band and split it! This can then be retrieved with an endoscope. The wire has to be divided through a skin incision for the access port.

 The decision between 1 and 2 might depend on extent of band into the stomach and whether the buckle is on the outside (which might make transgastric removal more difficult).