Lap band complications: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | |||
- laparoscopic adjustable gastric banding | - laparoscopic adjustable gastric banding | ||
| Line 24: | Line 13: | ||
- patients typically discharged same day or POD #1 | - patients typically discharged same day or POD #1 | ||
==Presentation== | |||
- abdominal, chest or neck/throat pain | - abdominal, chest or neck/throat pain | ||
| Line 32: | Line 20: | ||
- sepsis, abdnormal vitals | - sepsis, abdnormal vitals | ||
==Complications== | |||
a. Early – at or near time of banding or adjustment of band | a. Early – at or near time of banding or adjustment of band | ||
| Line 61: | Line 49: | ||
*Port Ulceration | *Port Ulceration | ||
==Workup== | |||
Lab w/u dictated by presentation | Lab w/u dictated by presentation | ||
| Line 75: | Line 63: | ||
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== | |||
- early surgical consultation key for all patients suspected of having complications | - early surgical consultation key for all patients suspected of having complications | ||
Revision as of 15:57, 5 July 2011
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
Presentation
- abdominal, chest or neck/throat pain
- nausea, vomiting, food intolerance
- sepsis, abdnormal vitals
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
- Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
b. 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
Workup
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
Source
Ann Emerg Med 2006;47:160-6, Tintinalli's