Lap band complications

Revision as of 16:18, 22 March 2016 by Ostermayer (talk | contribs) (Text replacement - "Category:Surg" to "Category:Surgery")

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

  • 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 abx coverage for intra-abd and skin flora
  • Tubing Dislodgement
  • 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

References

  • Ann Emerg Med 2006;47:160-6