Lap band complications
Background
- Laparoscopic adjustable gastric banding
- Band placed at gastroesophageal 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, abnormal 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 antibiotic coverage for intra-abdominal and skin flora
- Tubing Dislodgement
- Port Ulceration
Evaluation
- Lab workup dictated by presentation
- Obtain an upright KUB to assess band position & slippage
- Phi (φ) angle- Angle between a vertical line oriented through the spine and a second line running on the long axis of the lap band
- Normal is 4-58 degrees
- Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction
- CT Abd/Pelvis 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
Management
- Early surgical consultation key for all patients suspected of having complications
- Intra-abdominal sepsis management (fluids, antibiotics)
- Remember to dose antibiotics for morbid obesity if necessary
- Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation