Difference between revisions of "Lap band complications"

(Source)
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*patients typically discharged same day or POD #1  
 
*patients typically discharged same day or POD #1  
  
==Presentation==
+
==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, abdnormal vitals  
  
==Complications==
+
==Differential Diagnosis==
#Early – at or near time of banding or adjustment of band  
+
===Early===
##Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB  
+
''At or near time of banding or adjustment of band''
##Intra-abdominal bleeding  
+
#Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB  
##Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
+
#Intra-abdominal bleeding  
#Late
+
#Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
##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
 
  
==Workup==
+
===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
  
Lab w/u dictated by presentation  
+
==Diagnosis==
 
+
*Lab w/u 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)  
        - 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  
Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction  
+
*Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion  
 
 
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  
 
  
 
==Treatment==
 
==Treatment==
 
+
*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  
 
+
*remember to dose antibiotics for morbidly obese as neccesary  
- intra-abdominal sepsis EGDT, antibiotics  
+
*if impending gastric necrosis due to edema/recent band inflation  
 
+
*Can deflate band via port site, otherwise wait for surgeon  
- 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  
 
  
 
==See Also==
 
==See Also==
[[Weight Loss Surgery Complications]]
+
*[[Weight Loss Surgery Complications]]
  
 
==Source==
 
==Source==

Revision as of 12:25, 12 May 2015

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

Clinical Features

  • abdominal, chest or neck/throat pain
  • nausea, vomiting, food intolerance
  • sepsis, abdnormal vitals

Differential Diagnosis

Early

At or near time of banding or adjustment of band

  1. Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB
  2. Intra-abdominal bleeding
  3. Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea

Late

  1. Chronic Slippage - weeks to years after adjustment or application
    1. herniation of stomach through band
    2. can occur long after surgery
    3. may progress to gastric necrosis and perforation
  2. Gastric Erosion - band can erode through the full thickness of the gastric wall 
    1. can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis
  3. Port Complications
    1. primary overlying skin infection may represent extension of intra-abdominal process
    2. need abx coverage for intra-abd and skin flora
  4. Tubing Dislodgement
  5. Port Ulceration

Diagnosis

  • 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

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

See Also

Source

Ann Emerg Med 2006;47:160-6, Tintinalli's