Band Slippage – a Potentially Life-Threatening Complication after Laparoscopic Adjustable Gastric Banding

Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy

Morbid obesity is an increasing health problem, and bariatric surgery is a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical post-operative findings of the Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG) procedures on upper gastrointestinal (UGI) series and computerized tomography (CT) are presented. An overview of the potential complications is provided in addition to a description of potential pitfalls in interpreting these studies.

Three-year experience of pouch dilatation and slippage management after laparoscopic adjustable gastric banding

PURPOSE

Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications.

MATERIALS AND METHODS

The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications.

RESULTS

From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period.

CONCLUSION

The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.

Gastric bands: what the general radiologist should know

Obesity in the UK is increasing, it is estimated that in England 24% of men and 25% of women are obese.(1,2) In recent years bariatric surgery has become increasingly common and is effective in producing long-term weight loss.(4,5) The most popular form of bariatric surgery in Europe is laparoscopic adjustable gastric banding (LAGB).(6) Radiologists play a key role assessing the normal function of bands, adjusting their filling under fluoroscopic guidance, and in recognizing and managing complications. This review will describe the general principles of LAGB; how they are assessed, how to recognize the most common complications, an overview of the appearances of the bands used in the UK, and novel developments in their use and design.

The surgical management of obesity with emphasis on the role of post operative imaging

The role of surgery in the morbidly obese is becoming more prominent. There are a variety of surgical approaches which can be used and radiology plays a crucial role in post operative follow up, particularly in the management of complications. Many general radiologists remain unfamiliar with both the normal and abnormal appearances after bariatric surgery and this pictorial review aims to bridge this gap.

Acute dysphagia: an unusual treatable cause

Bariatric surgery is a rapidly expanding surgical sub-speciality, with a large proportion of the relevant surgical procedures being performed in the private sector. Acute complications of newer surgical procedures can lead to emergency department presentation, with which the staff may be unfamiliar. A 34-year-old woman was seen in the emergency department with acute total dysphagia following laparoscopic adjustable gastric banding, which was treated successfully by a simple bedside procedure.

Acute dysphagia: an unusual treatable cause

Bariatric surgery is a rapidly expanding surgical sub-speciality, with a large proportion of the relevant surgical procedures being performed in the private sector. Acute complications of newer surgical procedures can lead to emergency department presentation, with which the staff may be unfamiliar. A 34-year-old woman was seen in the emergency department with acute total dysphagia following laparoscopic adjustable gastric banding, which was treated successfully by a simple bedside procedure.

Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications

Laparoscopic adjustable gastric banding (LAGB) is a safe and effective means of weight loss for patients who have morbid obesity. LAGB currently is the least invasive surgical treatment for morbid obesity. Radiologists must be aware of the expected postoperative imaging findings, the optimal technique for radiologic assessment, and the postoperative complications that may occur. In addition, because band-adjustment procedures often are performed fluoroscopically, the radiologist may play a direct role in the management of weight loss in patients following LAGB.

Palatal Ulcers due to Vomiting after Gastric Band Tightening

Adjustable gastric banding is a widely used modality in some countries for the treatment of morbid obesity, and several complications have been reported. We report the unusual case of a patient who developed bilateral ulcers of the palate after intense vomiting caused by tightening of her gastric band.

Gastric Slippage as an Emergency: Diagnosis and Management

Laparoscopic adjustable gastric banding (LAGB) is an increasingly common procedure for morbid obesity. The most prevalent complication following LAGB is band slippage leading to gastric prolapse. These cases often present to the emergency department where surgeons need to appropriately diagnose and stabilize the patient, prior to any surgical intervention. It is imperative that surgeons at all levels of training implement an organized, effective acute management plan to reduce the morbidity and mortality associated with this life-threatening condition. This report highlights the case of a gastric banding patient who presented to an emergency department >1 year after a LAGB operation had been performed, with dysphagia. The diagnosis of gastric prolapse can be overlooked, with potentially serious consequences.