Lap band complications: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
*abdominal, chest or neck/throat pain | *[[abdominal pain|Abdominal]], [[chest pain|chest]] or [[neck pain|neck]]/[[sore throat|throat pain]] | ||
* | *[[Nausea/vomiting]], food intolerance | ||
* | *[[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 | **need antibiotic coverage for intra-abdominal and skin flora | ||
*Tubing Dislodgement | *Tubing Dislodgement | ||
*Port Ulceration | *Port Ulceration | ||
== | ==Evaluation== | ||
*Lab | *Lab workup dictated by presentation | ||
*KUB-upright to assess band position & slippage | *[[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 | *Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | ||
*CT | *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 | ||
== | ==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 | ||
*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 | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Revision as of 22:51, 29 September 2019
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