Lap band complications: Difference between revisions

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'''Complications of Lap Band Surgery'''


<u>'''1. Background <br/>'''</u>
==Background==


<u>'''2. Presentation <br/>'''</u>
*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


<u>'''3. Complications - early and late<br/>'''</u>


<u>'''&nbsp;4. Workup <br/>'''</u>
==Clinical Features==


<u>'''5. Disposition'''</u
*[[Special:MyLanguage/abdominal pain|Abdominal]], [[Special:MyLanguage/chest pain|chest]] or [[Special:MyLanguage/neck pain|neck]]/[[Special:MyLanguage/sore throat|throat pain]]
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]], food intolerance
*[[Special:MyLanguage/Sepsis|Sepsis]], abnormal vitals


'''1. Background<br/>'''


- laparoscopic adjustable gastric banding
==Differential Diagnosis==


- band placed at GE junction and inflated to limit food passage


- band constriction adjustable via reservoir
===Early===


- subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention
''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  
- postoperative complications near 10% over lifetime of patient
 
- patients typically discharged same day or POD #1
 
<br/>'''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  
*Intra-abdominal bleeding  
*Perforated viscus Esophageal pouch dilation – pain, vomiting, nausea
*Perforated viscus  
**Esophageal pouch dilation – pain, vomiting, nausea


b. Late


*Chronic Slippage - weeks to years after adjustment or application
===Late===


&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - herniation of stomach through band
''Weeks to years after adjustment or application''
 
*Chronic Slippage
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - can occur long after surgery  
**herniation of stomach through band  
 
**can occur long after surgery  
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - may progress to gastric necrosis and perforation
**may progress to gastric necrosis and perforation  
 
*Gastric Erosion  
*Gastric Erosion - band can erode through the full thickness of the gastric wall&nbsp;
**Band can erode through the full thickness of the gastric wall&nbsp;
 
**can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis  
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - 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
*Port Complications - primary overlying skin infection may represent extension of intra-abdominal process
**need antibiotic coverage for intra-abdominal and skin flora  
 
*Tubing Dislodgement
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - need abx coverage for intra-abd and skin flora
 
*Tubing Dislodgement&nbsp;
*Port Ulceration
*Port Ulceration


'''4. Workup'''
Lab w/u dictated by presentation
KUB-upright to assess band position & slippage
&nbsp; &nbsp; &nbsp; &nbsp; - 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
==Evaluation==


'''5. Treatment <br/>'''
*Lab workup dictated by presentation
*Obtain an upright [[Special:MyLanguage/KUB|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


- early surgical consultation key for all patients suspected of having complications


- intra-abdominal sepsis EGDT, antibiotics
==Management==


- remember to dose antibiotics for morbidly obese as neccesary
*Early surgical consultation key for all patients suspected of having complications
*Intra-abdominal [[Special:MyLanguage/sepsis|sepsis]] management (fluids, antibiotics)
*Remember to dose [[Special:MyLanguage/Antibiotic|antibiotics]] for morbid obesity if necessary
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation


- if impending gastric necrosis due to edema/recent band inflation


can deflate band via port site,&nbsp;otherwise wait for surgeon
==See Also==


*[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]]
*[[Special:MyLanguage/Medical device complications|Medical device complications]]




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==References==
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''Ann Emerg Med. 2006;47:160-166., Tintinalli''


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[[Category:GI]]
[[Category:Surgery]]
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Latest revision as of 23:16, 4 January 2026


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


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


See Also


References

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