Lap band complications

Revision as of 07:53, 14 June 2011 by Nwilkes (talk | contribs) (Created page with "<parsererror style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black"> === This page contains the...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

<parsererror style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black">

This page contains the following errors:

error on line 2 at column 156: Opening and ending tag mismatch: meta line 0 and span

Below is a rendering of the page up to the first error.

</parsererror> Complications of Lap Band Surgery

1. Background

2. Presentation

3. Complications - early and late

 4. Workup

5. Disposition</u

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

2. Presentation

- abdominal, chest or neck/throat pain

- nausea, vomiting, food intolerance

- sepsis, abdnormal vitals

3. 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

4. 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

5. 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

<meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="Content-Style-Type" content="text/css"><title></title><meta name="Generator" content="Cocoa HTML Writer"><meta name="CocoaVersion" content="949.54"><style type="text/css"> p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica}</style> Ann Emerg Med. 2006;47:160-166., Tintinalli