Lap band complications

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

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

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

- 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

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

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