Difference between revisions of "Lap band complications"

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==Background==
 
==Background==
*laparoscopic adjustable gastric banding  
+
*Laparoscopic adjustable gastric banding  
*band placed at GE junction and inflated to limit food passage  
+
*Band placed at gastroesophageal junction and inflated to limit food passage  
*band constriction adjustable via reservoir  
+
*Band constriction adjustable via reservoir  
*subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention  
+
*Subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention  
*postoperative complications near 10% over lifetime of patient  
+
*Postoperative complications near 10% over lifetime of patient  
*patients typically discharged same day or POD #1  
+
*Patients typically discharged same day or POD #1
  
 
==Clinical Features==
 
==Clinical Features==
*abdominal, chest or neck/throat pain  
+
*Abdominal, chest or neck/throat pain  
*nausea, vomiting, food intolerance  
+
*Nausea, vomiting, food intolerance  
*sepsis, abdnormal vitals  
+
*Sepsis, abnormal vitals
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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*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
+
*Perforated viscus  
 +
**Esophageal pouch dilation – pain, vomiting, nausea
  
 
===Late===
 
===Late===
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*Port Complications  
 
*Port Complications  
 
**primary overlying skin infection may represent extension of intra-abdominal process
 
**primary overlying skin infection may represent extension of intra-abdominal process
** need abx coverage for intra-abd and skin flora  
+
**need antibiotic coverage for intra-abdominal and skin flora  
 
*Tubing Dislodgement
 
*Tubing Dislodgement
 
*Port Ulceration
 
*Port Ulceration
  
==Diagnosis==
+
==Evaluation==
*Lab w/u dictated by presentation  
+
*Lab workup 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)  
+
**normal: 30-45 deg to the horizontal (~2 o'clock)  
 
*Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction  
 
*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  
+
*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  
+
*Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion
  
==Treatment==
+
==Management==
*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  
+
*Intra-abdominal [[sepsis]] management (fluids, antibiotics)
*remember to dose antibiotics for morbidly obese as neccesary
+
*Remember to dose [[Antibiotic|antibiotics]] for morbid obesity if necessary
*if impending gastric necrosis due to edema/recent band inflation  
+
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation  
*Can deflate band via port site, otherwise wait for surgeon
 
  
 
==See Also==
 
==See Also==
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*[[Medical device complications]]
 
*[[Medical device complications]]
  
==Source==
+
==References==
''Ann Emerg Med 2006;47:160-6, Tintinalli's''
+
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]
[[Category:Surg]]
+
[[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