Lap band complications

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

Source

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