Complications associated with adjustable gastric banding A Surgeon's Guide

 

Pouch enlargement

Pouch enlargement (type-III prolapse) is diagnosed when dilation of the proximal gastric pouch is present with or without change in the angle of the band and in the absence of signs of obstruction.

 The lower esophagus may or may not be dilated. Pouch enlargement is a pressure-related phenomenon that may be surgically induced by band over inflation or overeating with resulting high pressure in the pouch.

Symptoms of pouch enlargement include lack of satiety, heartburn, regurgitation and occasional chest pain. The diagnosis is made with an upper gastrointestinal series 

Nonoperative treatment includes complete band deflation, low-calorie diet, re-enforcement of portion size and follow-up contrast study in 4–6 weeks. If the band position and the pouch size return to normal, then the band can be incrementally re inflated. A study by Moser and colleagues demonstrated that this conservative approach to pouch enlargement was successful in up to 77% of patients. Conservative treatment is considered unsuccessful when the pouch fails to recover its original size after 8–10 weeks. In this cir****tance, surgical treatment with either band removal or replacement is indicated.

 

Band slip

Band slip may be defined as cephalad prolapse of the body of the stomach or caudal movement of the band. Other published literature report an incidence of slip of 1%–22%.

Since the cross-sectional area of the stomach is larger at the body than at the level of the angle of His (normal band position), complete obstruction of the stomach can occur when the band slips. Band slip can be posterior or anterior, depending on whether the anterior or posterior region of the stomach herniates through the band.

 

Anterior slip (type-I prolapse)

 

Anterior slip results from upward migration of the anterior wall of the stomach through the band. This can be due to insufficient anterior fixation and disruption of the fixation sutures. The second cause may be related to increased pressure in the pouch due to early solid food, vomiting, overeating or early (< 4 wk) band fill.

 

Posterior slip (type-II prolapse)

  Posterior slip is defined as a herniation of the posterior wall of the stomach through the band. This is usually related to the surgical technique but is less frequent now with adoption of the pars flaccida approach instead of the perigastric approach 

In both types of slip, the patient usually presents with dysphagia, vomiting, regurgitation and food intolerance. The diagnosis is made by upper gastrointestinal series. Complications related to band slip include gastric perforation, necrosis of the slipped stomach (type-V prolapse), upper gastrointestinal bleeding and aspiration pneumonia.

Type-IV prolapse

A type-IV prolapse is defined as an immediate postoperative prolapse and is usually due to placing the band too low on the stomach.

Band slip types (I, II, IV and V) are acute and always require surgical intervention. Laparoscopic removal or repositioning of the band is the preferred method of treatment. Pouch enlargement is a chronic complication that should be managed nonoperatively in the first instance, and surgical readjustment is reserved only for those patients in whom conservative treatment fails.

 

Band erosion

Band erosion is an uncommon complication of LAGB. In this scenario, the band gradually erodes through the stomach wall and into the gastric lumen. The incidence is less than 1%, with a reported prevalence varying from 0% to 11%.

 The etiology of band erosion may be the result of gastric-wall injury during band placement or tight anterior fixation, especially around the band buckle.

A high index of suspicion is required for diagnosis of band erosion as most patients are asymptomatic. When symptomatic, complaints related to erosion include loss of restriction, nonspecific epigastric pain, gastrointestinal bleeding, intra-abdominal abscesses or port-site infection. The diagnosis is often made at the time of gastroscopy. The recommended treatment is complete removal of the eroded gastric band laparoscopically or via laparotomy.

 

Port-site infection

Port-site infections can be classified as early and late. Early infections will manifest with the cardinal signs of erythema, swelling and pain. These infections typically occur within the immediate postoperative period and may be reduced by the use of perioperative antibiotics. Early infection with cellulitis alone may be treated with oral antibiotics. If the response is inadequate, then intravenous antibiotic use is warranted. When the infection does not respond to intravenous antibiotics and is limited to the port, the port should be removed and the tubing knotted and left inside the abdomen. Once the local infection is resolved, a new port may be placed and tubing connected with laparoscopic guidance. Late port site infections are often caused by delayed band erosion with ascending infection. This usually manifests several months after surgery and can be associated with loss of restriction. These infections typically do not respond well to antibiotic treatment. If left undetected, band infection can evolve into potentially life-threatening intra-abdominal sepsis. Gastroscopy will confirm the diagnosis of band erosion. This complex clinical scenario is treated most expeditiously by removal of the band.

 

Port breakage

Breakage or damage of the port typically refers to leakage through a damaged port septum or tubing leading into the port. The use of a standard coring needle is strongly discouraged, and only Huber (noncoring) needles should be used to access the port. If port access is difficult or if the tubing connected to the port is at risk of perforation, then band adjustment under fluoroscopy is advised. Port breakage usually manifests as a slow leak with the loss of the injected fluid volume on aspiration and the absence of restriction. It can be difficult to identify the leak site but local exploration of the port site can confirm the diagnosis.

I'm posting this because these are things we as  Lap Band Patients should be aware of, I'm a firm believer of "Being forewarned is being Forearmed

 

 

Thank you for the info!

Would you be so kind as to post the "Complications Associated with the OTHER Surgeries" as well? That would be great!

Your WELCOMEBette

I was Searching for Lap Band information at  the Us National Library of Medicine,National Institute of health I was hoping that this Post could be put into the "sticky notes" so that it's ALWAYS present.? (hint, hint) What do you think Moderators?

But I will definitely keep looking for the "other surgery complications as well.