Lap band complications

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

Presentation

• abdominal, chest or neck/throat pain
• nausea, vomiting, food intolerance
• sepsis, abdnormal vitals

Complications

1. Early – at or near time of banding or adjustment of band
   1. Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
   2. Intra-abdominal bleeding
   3. Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
2. Late
   1. Chronic Slippage - weeks to years after adjustment or application
      1. herniation of stomach through band
      2. can occur long after surgery
      3. may progress to gastric necrosis and perforation
   2. Gastric Erosion - band can erode through the full thickness of the gastric wall 
      1. can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis
   3. Port Complications
      1. primary overlying skin infection may represent extension of intra-abdominal process
      2. need abx coverage for intra-abd and skin flora
   4. Tubing Dislodgement
   5. Port Ulceration

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

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

Source

Ann Emerg Med 2006;47:160-6, Tintinalli's