Lap band complications: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
*abdominal, chest or neck/throat pain | |||
* | *[[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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Early=== | ===Early=== | ||
''At or near time of banding or adjustment of band'' | ''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=== | ===Late=== | ||
== | ''Weeks to years after adjustment or application'' | ||
*Lab | *Chronic Slippage | ||
*KUB | **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 [[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 | *Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction | ||
*CT | *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 | *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 [[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 | |||
==See Also== | ==See Also== | ||
== | *[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]] | ||
*[[Special:MyLanguage/Medical device complications|Medical device complications]] | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category: | [[Category:Surgery]] | ||
</translate> | |||
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
- 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
See Also