Lap Band Leaks: What You Should Know
Lap Band Leaks: What You Should Know
A Lapband leak is suspected when a patient that previously had adequate restriction feels a change in the amount of restriction. This can happen suddenly or over a period of time, depending on the size of the leak. If there is a leak of the lap band, the band will not be able to be adequately filled and will not provide restriction, or function properly. There are four types of lapband leaks that can occur to the lapband once it is placed, based on the location: (1) Leaks at the lapband balloon, (2) Leaks at the lapband tube connections, (3) Leaks at the body of the tube, and (4) Port membrane leaks.
(1) Leaks at the Lapband Balloon
Leaks in the lap band balloon can be unintentionally caused by needle punctures during surgery, or may occur over time in certain factory weak points of the balloon.
Leak at Lapband balloon http://www.thebariatric.com
Figure 1.0 In the figure above, you can see the lap band (white rectangular shape), which has been filled with contrast fluid. The arrow points to a small amount of fluid that has moved outside the band from a small leak in the balloon of the lap band (VG).
Lap-Band Leak http://www.thebariatric.com
Figure 1.1 This is another image of a lap band balloon leak. A thin line of contrast fluid can be seen outside of the lap band, surrounding both the band and the tube.
Lapband Leak http://www.thebariatric.com
Figure 1.2 The lap band balloon can be seen in the centre of this image (rectangular shape, slanted to the left). In this case, there is a larger leak of contrast fluid which is more easily visible around the lap band balloon (arrow).
Lapband leak seen during surgery http://www.thebariatric.com
Figure 1.3 In this case, there was a leak in the lap band balloon, and surgery was required to remove the band. During surgery, the leak was very clearly seen when fluid was pushed through the lap band, to reveal the location of the leak. (The arrow points to the line of fluid leaking from the AMI band).
(2) Leaks at the Lapband Tube Connection
Leaks can occur within the Lapband tube connection if there is a break or fracture of the tube next to the metal connector. Breaks or fractures may be due to physical movement over time, when considering the materials of the connections (metal and silicone). If the “fracture" is complete, it can be easily diagnosed with an x-ray film (plain film), without needing to inject contrast fluid.
Lapband plain x-ray film http://www.thebariatric.com
Figure 2.0 Above, we can see the lapband port in the lower, right corner, with the tube extending to the left in the x-ray image. There is a complete fracture (break) in the tube. The distal end of the tube is near the port, which means the tube may still be in the abdominal wall.
Lapband Leak http://www.thebariatric.com
Figure 2.1 Above, we can see the lapband port near the bottom of the x-ray image, with a complete fracture (break) in the tube, which is curled up at the top of the image. This shows that the tube is likely still inside the abdominal cavity.
Port of a Lapband leak http://www.thebariatric.com
Figure 2.2 Above is a photo of the lapband port that was removed during surgery from Figure 2.1.
If the “fracture" is incomplete, it is necessary to inject contrast inside the system in order to diagnosis the problem.
Figure 2.3 This shows an incomplete fracture, with the tube in place.
Port of a Lapband leak http://www.thebariatric.com
Figure 2.4 This is the port removed from the above case (Figure 2.3).
Port of a Lapband leak http://www.thebariatric.com
Figure 2.5 In this plain x-ray film, the port can be seen in the bottom right corner. There is a slight bend in the tube at the connection point (upper right corner of the film).
Figure 2.6 As a leak was suspected, contrast fluid was passed through this lapband port. A large amount of contrast fluid is seen at the bend, in the top right (the connection point).
In some cases, it is not possible to indentify a leak with x-rays. Therefore, the diagnosis of a leak may need to be done at the time of surgery.
Lap-Band Leak http://www.thebariatric.com
Figure 2.7 In this x-ray with contrast fluid, there is no evidence of a leak.
Tube leak near the port http://www.thebariatric.com
Figure 2.8 This leak was not demonstrated with x-rays. As the leak was suspected, surgery was required to find the location of the leak.
(3) Leaks at the Body of the Tube
These lap band leaks are usually iatrogenic. This means that the leak was caused by an unintentional needle puncture, during a fill that was done without using fluoroscopy to guide the needle. These kinds of leaks are very common in office fills. Even in the best hands, there is always a risk of puncturing the tube during a lap band adjustment. This is one of the reasons that we always recommend fills to be done under fluoroscopy.
Lapband tube puncture http://www.thebariatric.com
Figure 3.0 A leak can be seen in the body of the tube, close to the connection. This leak was made with a needle at the time of an adjustment (office fill).
Lap-band Tube puncture http://www.thebariatric.com
Figure 3.1 The leaking portion of the tube was removed during surgery.
(4) Port Membrane Leaks
This type of leak usually occurs when the patient has received many fills, or when the adjustment was done using a standard needle. Only Huber (non-coring) needles (Figure 4.2) should be used to perform fills or adjustments. The silicone membrane of the port may be damaged if any other type of needle is used.
Lap-band Port Leak http://www.thebariatric.com
Figure 4.0 The lapband leak is just in front of the port, where contrast can be seen.
Lap-band Port Membrane Leak http://www.thebariatric.com
Huber Needle http://www.thebariatric.com
Figure 4.1 During surgery, we can see a leak at the port membrane as seen by the bubbles that are produced when the port is placed in water.
Figure 4.2 Huber (non-coring) needle.
Final Thoughts
Every day, the lap band manufacturers are improving the design and functionality of the gastric bands in order to prevent complications such as leaks. However, there is always a small risk of leaks over time. Many types of lap band leaks can be avoided by careful handelling the gastric band at the time of the surgery and by doing the lap band fill or adjustment under the fluoroscopy guide, and finally by using the right non-core needle.
Arturo Rodriguez, MD Bariatric Surgeon Susana González, MD Radiologist http://www.thebariatric.com
These lap band leaks are usually iatrogenic. This means that the leak was caused by an unintentional needle puncture, during a fill that was done without using fluoroscope to guide the needle. These kinds of leaks are very common in office fills. Even in the best hands, there is always a risk of puncturing the tube during a lap band adjustment. This is one of the reasons that we always recommend fills to be done under fluoroscope.
If punctures are common when fills are done without fluoroscope, why the %^$#* are most of our fills done by nurses learning to do fills and without fluoroscope??? I am not dis'ing the nurses, but after having Carolyn and Dr Roy miss the opening in my port at least 8 times, I am really questioning the wisdom of fills done without a scope. Is this practice just a budget saver?
You are the toughest of the toughest.
on 10/11/09 8:37 pm - saint john, Canada
I decided that I did not want the band long befire I ever laid eyes on Dr, B, I had been reading on the lap band sites and was reading so many many stories like the ones here about problems and fustrations with the band. During my first consult with Dr. B., he almost had me convinced to have the band. When I got home and thought more about it, I knew I did not want the band. At the time we were going to be moving to northern Canada where no fills would be possible. That was one consideration but not the main one. I decided that on my next consult with Dr. B.tat I would request RnY and if it were not possible then I would walk away from wls altogether. That was a tough decision after waiting 6 years but I was absolutely certain about it. At 47 with a number of health issues I was not sure he would do the proceedure. Thankfully that wonderful man agreed with me that I could have RnY
I've had some problems with RnY but most of them were one time issues and once rectified were gone. I don't know how you guys cope with the fills, unfills, restrictions, lack of restriction, dieting, hunger and the travelling back aqnd forth for fills. I wouldn't have the nerves, I'd be a freaking basket case (or more so). Kudos, Kudos to you bandsters. I can't say it enough and know that I truly feel for you and your troubles. I too really feel that you guys are a brave bunch.
I guess the only thoing worse is the people out there who had no choice but have the band. It sounds so unfair to me.
I am not trying to exault RnY over the band. Most bandsters love their bands, I just know it was not for me.
weight surgery day Feb 12 2009 251
Current weight 174
First goal 199 Onederland ( Reached goal Aug 8 @ 198lbs)
Second goal 193 Century Club ( Reached on Aug 30 2009 )
Third goal 180 pounds ( Reached on Nov.23 2009 ) (my personal goal)
Final goal 170 pounds ( reached Jan 5 2011) ( only stayed that weight breifly)
I'm still maggie from the grove
I LOVE MY RNY !!!2 years down, a lifetime to go!!!!
LIVE, LAUGH, LOVE, NOBODY GETS OUT ALIVE
You also read on a lot of success stories with the band and I don't regret it. The way I see it is that there is much more inconveniences of being morbidly obese when you compare the inconveniences of the band. And all the problems mentioned "may" happen. It often doesn't...
My friend in Boston had ONE fill in one year and is in love with her band. No complications. So I try to keep myself educated but not get discouraged. There are many pros and cons with any WLS or any operations in general...
BMI
Start- 47.2
Current- 41.9
Goal- 25
So, for the bad - Sometimes I get a little discouraged with the traveling, missing work, cost, fills and lack of restriction. I have had 4 fills, my last one on Oct. 8th. I was really hoping this one would make a difference and I can say it has made a slight difference. I can still eat anything: salads, bread, meats and of course ice cream
The only difference is that I have to be careful to chew, chew and chew some more. In other words I have to follow the rules. I have had no blocks or BP's - I will need to go for another fill.And now the good - In spite of these irritants, I have lost 64 pounds in 10 months - taking off the weight at a healthy pace, I am no longer morbidly obese, I can now work all day and then come home and try to meet the needs of my mother and my son without falling into bed at the end of the day totally exhausted, I have stopped all meds except a thyroid, and allergy pill, I feel like "I'm gonna make it" and not like, "I can't to this anymore". One other thing - putting myself first for a change and saying "no" when I need to.
I don't see any WLS as easier than another. They all have their down sides and hopefully their up sides. The band does work and when I finally get to that sweet spot... oh happy day! The last time I was in Moncton I just wanted to say "fill 'er up". I still would like to see the weight just disappear but I also want to be healthy when this is all done. I trust the folks in Moncton will not do anything that will make this journey a risk to me. I sometimes have to remind myself that they are the ones with the training and some things I cannot control - I'm not good at letting go of control
(Wonder if I can get a band for that??? HAHA)I read this forum daily and I marvel at the accomplishments and determination of the people who contribute on a regular basis.
A Band for Control hmmm, I think I need one of those too. Ha ha.
Sometimes going forward is slower than we want, sometimes going forward is not so easy since it is an uphill climb but when we get to the top of the hill well that is just great. Like that song on the radio - Its not about how fast I get there, not about what's waiting on the other side -its about the climb.
Climbing,
Ann
