Lap band complications: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Lab | *Lab workup dictated by presentation | ||
*KUB-upright to assess band position & slippage | *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 | *Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | ||
*CT | *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 | *Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion | ||
==Management== | ==Management== | ||
Revision as of 23:52, 12 July 2016
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, abdnormal 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 abx coverage for intra-abd and skin flora
- Tubing Dislodgement
- Port Ulceration
Diagnosis
- 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 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
See Also
References
- Ann Emerg Med 2006;47:160-6