Difference between revisions of "Lap band complications"

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==Background==
=== This page contains the following errors: ===
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*Laparoscopic adjustable gastric banding
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*Band placed at gastroesophageal junction and inflated to limit food passage
=== <span class="Apple-style-span" style="font-size: 12px; font-weight: normal; ">'''Complications of Lap Band Surgery'''</span> ===
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*Band constriction adjustable via reservoir
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*Subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention
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*Postoperative complications near 10% over lifetime of patient
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*Patients typically discharged same day or POD #1
  
'''1. Background'''
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==Clinical Features==
 
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*Abdominal, chest or neck/throat pain  
'''2. Presentation'''
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*Nausea, vomiting, food intolerance  
 
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*Sepsis, abnormal vitals
'''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
 
 
 
<br/><u>'''2. Presentation'''</u>
 
 
 
- abdominal, chest or neck/throat pain  
 
 
 
- nausea, vomiting, food intolerance  
 
 
 
- sepsis, abdnormal vitals  
 
 
 
<u>'''3. Complications'''</u>
 
 
 
a. Early – at or near time of banding or adjustment of band
 
  
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==Differential Diagnosis==
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===Early===
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''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  
 
*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
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*Perforated viscus  
 
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**Esophageal pouch dilation – pain, vomiting, nausea
b. Late
 
 
 
*Chronic Slippage - weeks to years after adjustment or application
 
 
 
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - herniation of stomach through band
 
 
 
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - can occur long after surgery
 
 
 
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - may progress to gastric necrosis and perforation
 
 
 
*Gastric Erosion - band can erode through the full thickness of the gastric wall&nbsp;
 
 
 
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &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
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===Late===
 
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''Weeks to years after adjustment or application''
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - need abx coverage for intra-abd and skin flora  
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*Chronic Slippage
 
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**herniation of stomach through band
*Tubing Dislodgement&nbsp;
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**can occur long after surgery
 +
**may progress to gastric necrosis and perforation
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*Gastric Erosion
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**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
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*Port Complications  
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**primary overlying skin infection may represent extension of intra-abdominal process
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**need antibiotic coverage for intra-abdominal and skin flora  
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*Tubing Dislodgement
 
*Port Ulceration
 
*Port Ulceration
  
<u>'''4. Workup'''</u>
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==Evaluation==
 
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*Lab workup dictated by presentation  
Lab w/u dictated by presentation  
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*KUB-upright to assess band position & slippage  
 
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**normal: 30-45 deg to the horizontal (~2 o'clock)  
KUB-upright to assess band position & slippage  
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*Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction  
 
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*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)  
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*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  
 
 
 
<u>'''5. Treatment '''<br/></u>
 
 
 
- 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
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==Management==
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*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
  
 +
==See Also==
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*[[Bariatric surgery complications]]
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*[[Medical device complications]]
  
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==References==
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<references/>
  
''Ann Emerg Med 2006;47:160-6, Tintinalli's''
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[[Category:GI]]
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[[Category:Surgery]]

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