Difference between revisions of "Lap band complications"

(Created page with "<parsererror style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black"> === This page contains the...")
 
 
(29 intermediate revisions by 6 users not shown)
Line 1: Line 1:
<parsererror style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black">
+
==Background==
=== This page contains the following errors: ===
+
*Laparoscopic adjustable gastric banding
<div style="font-family:monospace;font-size:12px">error on line 2 at column 156: Opening and ending tag mismatch: meta line 0 and span </div>
+
*Band placed at gastroesophageal junction and inflated to limit food passage
=== Below is a rendering of the page up to the first error. ===
+
*Band constriction adjustable via reservoir
</parsererror>
+
*Subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention
'''Complications of Lap Band Surgery'''
+
*Postoperative complications near 10% over lifetime of patient
 +
*Patients typically discharged same day or POD #1
  
<u>'''1. Background <br/>'''</u>
+
==Clinical Features==
 +
*Abdominal, chest or neck/throat pain
 +
*Nausea, vomiting, food intolerance
 +
*Sepsis, abnormal vitals
  
<u>'''2. Presentation <br/>'''</u>
+
==Differential Diagnosis==
 
+
===Early===
<u>'''3. Complications - early and late<br/>'''</u>
+
''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  
<u>'''&nbsp;4. Workup <br/>'''</u>
 
 
 
<u>'''5. Disposition'''</u
 
 
 
'''1. Background<br/>'''
 
 
 
- 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
 
 
 
<br/>'''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  
 
*Intra-abdominal bleeding  
*Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
+
*Perforated viscus  
 +
**Esophageal pouch dilation – pain, vomiting, nausea
  
b. Late  
+
===Late===
 
+
''Weeks to years after adjustment or application''
*Chronic Slippage - weeks to years after adjustment or application
+
*Chronic Slippage
 
+
**herniation of stomach through band  
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - herniation of stomach through band
+
**can occur long after surgery  
 
+
**may progress to gastric necrosis and perforation  
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - can occur long after surgery  
+
*Gastric Erosion  
 
+
**Band can erode through the full thickness of the gastric wall&nbsp;
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - may progress to gastric necrosis and perforation
+
**can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis  
 
+
*Port Complications  
*Gastric Erosion - band can erode through the full thickness of the gastric wall&nbsp;
+
**primary overlying skin infection may represent extension of intra-abdominal process
 
+
**need antibiotic coverage for intra-abdominal and skin flora  
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis
+
*Tubing Dislodgement
 
 
*Port Complications - primary overlying skin infection may represent extension of intra-abdominal process
 
 
 
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - need abx coverage for intra-abd and skin flora
 
 
 
*Tubing Dislodgement&nbsp;
 
 
*Port Ulceration
 
*Port Ulceration
  
'''4. Workup'''
+
==Evaluation==
 
+
*Lab workup dictated by presentation  
Lab w/u dictated by presentation  
+
*KUB-upright to assess band position & slippage  
 
+
**normal: 30-45 deg to the horizontal (~2 o'clock)  
KUB-upright to assess band position & slippage
+
*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  
&nbsp; &nbsp; &nbsp; &nbsp; - nl 30-45 deg to the horizontal (~2 o'clock)
+
*Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion
 
 
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 <br/>'''
 
 
 
- 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,&nbsp;otherwise wait for surgeon
 
 
 
  
 +
==Management==
 +
*Early surgical consultation key for all patients suspected of having complications
 +
*Intra-abdominal [[sepsis]] management (fluids, antibiotics)
 +
*Remember to dose [[Antibiotic|antibiotics]] for morbid obesity if necessary
 +
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation
  
<span style="font-family:arial,helvetica,sans-serif;"><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">
+
==See Also==
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica}</style>
+
*[[Bariatric surgery complications]]
''Ann Emerg Med. 2006;47:160-166., Tintinalli''
+
*[[Medical device complications]]
  
 +
==References==
 +
<references/>
  
</meta></meta></meta></meta></span>
+
[[Category:GI]]
 +
[[Category:Surgery]]

Latest revision as of 23:50, 30 May 2017

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, abnormal 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 antibiotic coverage for intra-abdominal and skin flora
  • Tubing Dislodgement
  • Port Ulceration

Evaluation

  • 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 management (fluids, antibiotics)
  • Remember to dose antibiotics for morbid obesity if necessary
  • Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation

See Also

References