WTH is a prolapsed band????

 I just read Nicki88's post about having a prolapsed band and having to have it removed and it's scaring the you-know-what out of me.  I'm having my band implanted on Friday.  

Can you tell me how that happens and if it can be avoided?  

Yikes!
Sharon

Sharon,

I believe she's referring to a band slip.  Prolapse is the term used to describe herniation of the stomach upwards through the band.  Instead of staying up at the top of the stomach near the fundus, the band slips downward.

A band slip can be caused by vomiting, overeating, failure to follow the post-op recovery diet, poor eating skills, a band that is too tight, an untreated hiatal hernia or a combination of these factors.  Symptoms of band slippage include vomiting, heartburn, reflux, foaming, chest pain and left shoulder pain. An otherwise benign change in angle of the band's position can cause the same symptoms, so try not to panic if this happens to you.

There are two types of slips:

1. Movement of the band when the sutures holding the stomach over the band break or fail - usually caused by excessive overeating that progressively stretches the upper stomach pouch.  Heartburn or reflux are the most common symptoms.
2. Movement of the lower stomach (gastric herniation or prolapse) up through the band - often caused by vomiting.  Blockage of the blood supply to the herniated portion of the stomach causes severe pain and can result in the death of that portion.

Band slippage may or may not be evident in an upper GI x-ray or upper endoscopy.  It is treated first by removing all of the fluid from the band.  If an unfill doesn't resolve the problem, additional surgery is required to reposition or replace the band (or to revise to a different weight loss surgery procedure altogether).

I had a band slip (apparently due to the hiatal hernia that my original surgeon chose not to repair) last summer.  It was cured by a total unfill and a month of "rest", then I began having my band gradually re-filled.  The earlier you catch a slip, the easier it is to fix.
Another OH member, Mellie, recently had surgery to reposition her slipped band.  I don't know why Nicki88's doctor felt she needs to have her band removed altogether.  The doc must have seen something during her barium swallow to make him/her think permanent damage had been done.

Jean

 I am going to do my very best to follow the doctor's instructions to the letter.  You have also given me topics to discuss further with my surgeon so I thank you.

Sharon

I think they said to have it removed b/c I want it out rather than repaired.  He has been treating me for 3 yrs. w/ all my problems and he knows the difficulty, plus my insurance doesn't pay so I am not going to pay to fix it.  I just want it out!

The following was originally posted by Naomi. I copied it as it is such a good report! Not sure what the crossed out bit is, it appeared like that in the original.

A clinical study was done in Germany to review complications following lap band surgery. Thirty-five hospitals were involved in the study, with 4138 patients that underwent gastric banding over a five-year period.  Lap Band long-term complications were described in 8.6%  of all patients.  The most common complications included: pouch dilation or enlargement (5.0%), lap band slippage (2.6%), and Lapband migration or erosion (1.0%).   (Stroh,C  Manger, T “Complications after adjustable gastric banding", Chirurg, 2006, Vol 77,pag 244-250)

 Normal Lap Band X-Ray Under Fluoroscopy

  Enlarged Lap Band Pouch    

What is Lap Band Slippage?

One of the long-term complications of lap band surgery is called “Lapband slippage" and can be defined as “when the Lapband and the stomach pouch are both prolapsed."  This means that the lap band has shifted position and the enlarged stomach pouch has also shifted or twisted so that food does not go through the lapband into the rest of the stomach. This may result in pain, discomfort, decreased appetite and inability to eat or drink, and vomiting. Lapband Slippage does not happen immediately but may take several months to develop. 

Large Lap Band Pouch

Lap Band Slippage generally develops in a progressive manner. As food intake is increased, the stomach begins to stretch and grow and the patient may stop losing weight or start to regain weight.  At this point, patients may only exhibit an enlarged stomach Lap band pouch.  This can be medically treated by deflating the lap band to release pressure and slow the growth of the pouch (successful in 70% of cases, or surgical treatment can be considered). However, if the enlarged lapband pouch continues to grow, the lapband progressively rotates until both the lap band and the enlarged pouch become prolapsed, resulting in Lap band slippage.  This is followed by functional stenosis (narrowing) of the stomach.  

 Lap Band Slippage

Lapband Slippage Symptoms typically include progressively worsening reflux, vomiting and epigastric complaints, which may increase to sudden near-total dysphagia (inability to swallow or eat anything, including saliva).

Risk factors or causes of lap band slippage include surgical technique, model of the  lapband used, early consumption of solid foods, early inflation or filling of the band, consumption of carbonated or sparkling beverages, and frequent vomiting.

Treatment for lap band slippage requires surgical intervention. The lapband must be repositioned or removed, based on the operative findings and condition of the stomach pouch. If appropriate, the surgeon and patient may elect to choose another type of bariatric procedure such as a Gastric Sleeve. 

How Do I Prevent Lap Band Slippage?

In order to decrease the risk of developing lap band slippage, it is important to follow the recommended diet following surgery and to avoid introducing solid foods too early.  In addition, the fills should not be started before 6 weeks post-operatively and these Lap band fills should be very gradual.  We also recommend that fills should be done under fluoroscopy, even if you are asymptomatic (no symptoms of lap band slippage), to be able to monitor the position of the lapband, and the size of the stomach pouch and condition of the esophagus. This will allow for early diagnosis of an enlarged stomach pouch or possible lap band slippage.

 Thanks for that Kate.  I really believe that if you give people all the information they can make informed decisions and possibly avoid a lot of heartache.

I am planning to do everything the right way to avoid any of this..........:)

Thanks again,
Sharon

I was worried I may have had a band slippage but now I am worried I may have erosion I havn't been well for over a year not related to my band and basically have been not following any sort of diet I pretty much maintained my weight though now I am feeling better and trying to start moving the weight down again in the past 2 months I gained 13 lbs I have been watching what I am eating for about 2 weeks and walking and the scale is not moving I am scared because I don't believe there are symptoms until it is too late does anyone have any idea if there are any symptoms of erosion??????

Erosion symptoms....well, I only had one.  Port infection.

 So sorry to hear you are not well - I sure hope you find a solution.  You should be able to get some answers on this board - everyone here is so helpful and nice. 

I want to thank you for your earlier post - because of it I learned a few things.

Feel better soon.
Sharon

 Add me to this list. Unfortunate. Undiagnosed hiatal hernia and band too tight for months=surgery to repair and a slight revision tactic. Dang it so much.