Lap band complications

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Background

  • Laparoscopic adjustable gastric banding
  • Band placed at gastroesophageal junction and inflated to limit food passage
  • Band constriction adjustable via reservoir
  • Subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention
  • Postoperative complications near 10% over lifetime of patient
  • Patients typically discharged same day or POD #1

Clinical Features

  • Abdominal, chest or neck/throat pain
  • Nausea, vomiting, food intolerance
  • Sepsis, abnormal vitals

Differential Diagnosis

Early

At or near time of banding or adjustment of band

  • Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
  • Intra-abdominal bleeding
  • Perforated viscus
    • Esophageal pouch dilation – pain, vomiting, nausea

Late

Weeks to years after adjustment or application

  • Chronic Slippage
    • herniation of stomach through band
    • can occur long after surgery
    • may progress to gastric necrosis and perforation
  • Gastric Erosion
    • Band can erode through the full thickness of the gastric wall 
    • can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis
  • Port Complications
    • primary overlying skin infection may represent extension of intra-abdominal process
    • need antibiotic coverage for intra-abdominal and skin flora
  • Tubing Dislodgement
  • Port Ulceration

Evaluation

  • Lab workup dictated by presentation
  • KUB-upright to assess band position & slippage
    • normal: 30-45 deg to the horizontal (~2 o'clock)
  • Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction
  • CT Abd/Pelvis to assess for perforation (contained or free), abscess, intra-abdominal fluid or bleeding
  • Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion

Management

  • Early surgical consultation key for all patients suspected of having complications
  • Intra-abdominal sepsis management (fluids, antibiotics)
  • Remember to dose antibiotics for morbid obesity if necessary
  • Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation

See Also

References