Lap band complications: Difference between revisions
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=== | === <span class="Apple-style-span" style="font-size: 12px; font-weight: normal; ">'''Complications of Lap Band Surgery'''</span> === | ||
'''Complications of Lap Band Surgery''' | |||
'''1. Background''' | |||
'''2. Presentation''' | |||
'''3. Complications - early and late''' | |||
'''4. Workup''' | |||
'''5. Disposition''' | |||
'''1. Background''' | |||
- | - laparoscopic adjustable gastric banding | ||
- band | - band placed at GE 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 | ||
<br/>'''2. Presentation''' | - patients typically discharged same day or POD #1 | ||
<br/><u>'''2. Presentation'''</u> | |||
- abdominal, chest or neck/throat pain | - abdominal, chest or neck/throat pain | ||
- nausea, vomiting, food intolerance | - nausea, vomiting, food intolerance | ||
- sepsis, abdnormal vitals | - sepsis, abdnormal vitals | ||
'''3. Complications''' | <u>'''3. Complications'''</u> | ||
a. Early – at or near time of banding or adjustment of band | a. 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 | *Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB | ||
*Intra-abdominal bleeding | *Intra-abdominal bleeding | ||
*Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea | *Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea | ||
| Line 50: | Line 49: | ||
*Chronic Slippage - weeks to years after adjustment or application | *Chronic Slippage - weeks to years after adjustment or application | ||
- herniation of stomach through band | - herniation of stomach through band | ||
- can occur long after surgery | - can occur long after surgery | ||
- may progress to gastric necrosis and perforation | - may progress to gastric necrosis and perforation | ||
*Gastric Erosion - band can erode through the full thickness of the gastric wall | *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 | - 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 | *Port Complications - primary overlying skin infection may represent extension of intra-abdominal process | ||
- need abx coverage for intra-abd and skin flora | - need abx coverage for intra-abd and skin flora | ||
*Tubing Dislodgement | *Tubing Dislodgement | ||
*Port Ulceration | *Port Ulceration | ||
'''4. Workup''' | <u>'''4. Workup'''</u> | ||
Lab w/u dictated by presentation | Lab w/u dictated by presentation | ||
KUB-upright to assess band position & slippage | KUB-upright to assess band position & slippage | ||
- nl 30-45 deg to the horizontal (~2 o'clock) | - nl 30-45 deg to the horizontal (~2 o'clock) | ||
Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | ||
| Line 81: | Line 80: | ||
Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion | Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion | ||
'''5. Treatment <br/> | <u>'''5. Treatment '''<br/></u> | ||
- early surgical consultation key for all patients suspected of having complications | - early surgical consultation key for all patients suspected of having complications | ||
- intra-abdominal sepsis EGDT, antibiotics | - intra-abdominal sepsis EGDT, antibiotics | ||
- remember to dose antibiotics for morbidly obese as neccesary | - remember to dose antibiotics for morbidly obese as neccesary | ||
- if impending gastric necrosis due to edema/recent band inflation | - if impending gastric necrosis due to edema/recent band inflation | ||
can deflate band via port site, otherwise wait for surgeon | can deflate band via port site, otherwise wait for surgeon | ||
''Ann Emerg Med 2006;47:160-6, Tintinalli's'' | |||
Revision as of 07:56, 14 June 2011
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This page contains the following errors:
Complications of Lap Band Surgery
1. Background
2. Presentation
3. Complications - early and late
4. Workup
5. Disposition
1. Background
- laparoscopic adjustable gastric banding
- band placed at GE 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
2. Presentation
- abdominal, chest or neck/throat pain
- nausea, vomiting, food intolerance
- sepsis, abdnormal vitals
3. Complications
a. 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
b. Late
- Chronic Slippage - weeks to years after adjustment or application
- 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 abx coverage for intra-abd and skin flora
- Tubing Dislodgement
- Port Ulceration
4. Workup
Lab w/u dictated by presentation
KUB-upright to assess band position & slippage
- nl 30-45 deg to the horizontal (~2 o'clock)
Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction
CT AP 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
5. Treatment
- early surgical consultation key for all patients suspected of having complications
- intra-abdominal sepsis EGDT, antibiotics
- remember to dose antibiotics for morbidly obese as neccesary
- if impending gastric necrosis due to edema/recent band inflation
can deflate band via port site, otherwise wait for surgeon
Ann Emerg Med 2006;47:160-6, Tintinalli's