Lap band complications: Difference between revisions

Revision as of 12:25, 12 May 2015

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

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

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
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
Port Complications
1. primary overlying skin infection may represent extension of intra-abdominal process
2. need abx coverage for intra-abd and skin flora
Tubing Dislodgement
Port Ulceration

Diagnosis

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

Authors:

@@ Line 7: / Line 7: @@
 *patients typically discharged same day or POD #1
-==Presentation==
+==Clinical Features==
 *abdominal, chest or neck/throat pain
 *nausea, vomiting, food intolerance
 *sepsis, abdnormal vitals
-==Complications==
+==Differential Diagnosis==
-#Early – at or near time of banding or adjustment of band
+===Early===
-##Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
+''At or near time of banding or adjustment of band''
-##Intra-abdominal bleeding
+#Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
-##Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
+#Intra-abdominal bleeding
-#Late
+#Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
-##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&nbsp;
-###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
-==Workup==
+===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&nbsp;
+##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
-Lab w/u dictated by presentation
+==Diagnosis==
+*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)
-&nbsp; &nbsp; &nbsp; &nbsp; - 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
-Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction
+*Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion
-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
-- 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
-- intra-abdominal sepsis EGDT, antibiotics
+*if impending gastric necrosis due to edema/recent band inflation
+*Can deflate band via port site,&nbsp;otherwise wait for surgeon
-- 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,&nbsp;otherwise wait for surgeon
 ==See Also==
-[[Weight Loss Surgery Complications]]
+*[[Weight Loss Surgery Complications]]
 ==Source==