Lap band complications: Difference between revisions
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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 pain|Abdominal]], [[chest pain|chest]] or [[neck pain|neck]]/[[sore throat|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 | *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 | |||
===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 | |||
*Gastric Erosion | **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 | |||
*Port Complications | *Tubing Dislodgement | ||
*Tubing Dislodgement | |||
*Port Ulceration | *Port Ulceration | ||
==Evaluation== | |||
*Lab workup dictated by presentation | |||
Lab | *Obtain an upright [[KUB]] to assess band position & slippage | ||
**Phi (φ) angle- Angle between a vertical line oriented through the spine and a second line running on the long axis of the lap band | |||
KUB | **Normal is 4-58 degrees | ||
*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 | |||
Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | |||
CT | |||
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 [[Antibiotic|antibiotics]] for morbid obesity if necessary | |||
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation | |||
==See Also== | |||
*[[Bariatric surgery complications]] | |||
*[[Medical device complications]] | |||
== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category: | [[Category:Surgery]] | ||
Latest revision as of 15:15, 24 April 2022
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
- Obtain an upright KUB to assess band position & slippage
- Phi (φ) angle- Angle between a vertical line oriented through the spine and a second line running on the long axis of the lap band
- Normal is 4-58 degrees
- 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