Lap band complications
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</parsererror> Complications of Lap Band Surgery
1. Background
2. Presentation
3. Complications - early and late
4. Workup
5. Disposition</u
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
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="Content-Style-Type" content="text/css"><title></title><meta name="Generator" content="Cocoa HTML Writer"><meta name="CocoaVersion" content="949.54"><style type="text/css"> p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica}</style> Ann Emerg Med. 2006;47:160-166., Tintinalli
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