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

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

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

Lab workup dictated by presentation
KUB-upright to assess band position & slippage
- normal: 30-45 deg to the horizontal (~2 o'clock)
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 management (fluids, antibiotics)
Remember to dose antibiotics for morbid obesity if necessary
If impending gastric necrosis due to edema/recent band inflation
Can deflate band via port site, otherwise wait for surgeon