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Makovich Z, Patel B. Late-Onset Gastric Band Erosion Following Heavy Nonsteroidal Anti-inflammatory Drug Use. ACG Case Rep J 2024; 11:e01343. [PMID: 38645472 PMCID: PMC11030015 DOI: 10.14309/crj.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Laparoscopic adjustable gastric band (LAGB) surgery is now an uncommon bariatric procedure; however, complications may still be encountered. A 64-year-old man with a history of LAGB placement 13 years prior presented with 2 months of epigastric pain. He endorsed chronic heavy nonsteroidal anti-inflammatory drug use. Computed tomography showed inflammation around the LAGB tubing with near-complete, circumferential erosion of the LAGB into the fundus. Upper endoscopy confirmed erosion of the LAGB along with port tubing into the gastroesophageal junction and fundus. The patient was referred to a foregut surgeon who performed robotic band removal.
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Affiliation(s)
- Zachary Makovich
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Brijesh Patel
- Department of Gastroenterology, James A. Haley Veterans' Hospital, Tampa, FL
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Zhao W, Gao W, Li D, Jin L, Wu X, Liu H, Wang L, Zhao Y, Liu X, Chen P, Dong G. Management of esophagogastric fistula caused by adjustable gastric band erosion: A case report and literature review. Obes Res Clin Pract 2023; 17:428-431. [PMID: 37739856 DOI: 10.1016/j.orcp.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is commonly used in the treatment of morbid obesity. However, with clinical application and long-term follow-up, the shortcomings of this procedure were also exposed, bringing about surgery-related complications include dysphagia, intragastric band migration, slippage, and gastric band erosion. Lower esophageal and gastric fistula is a rare but dangerous complication after LAGB. We describe a case of esophagogastric fistula occurring twelve years after a laparoscopic band procedure and its successful management in a multidisciplinary and staged manner, followed by a short review of the literature.
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Affiliation(s)
- Wen Zhao
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wenxing Gao
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Dingchang Li
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Lujia Jin
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - XianSheng Wu
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Hao Liu
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Wang
- Medical School of Chinese PLA, Beijing, China; Department & Institute of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yingjie Zhao
- Department & Institute of General Surgery, the Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Xianqiang Liu
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Peng Chen
- Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing, China.
| | - Guanglong Dong
- School of Medicine, Nankai University, Tianjin 300071, China; Department & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
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Lu V, Kanhere H. A case report of septic shock and splenic abscess formation secondary to gastric band erosion: A rare complication of laparoscopic adjustable gastric banding. Int J Surg Case Rep 2020; 69:55-57. [PMID: 32276217 PMCID: PMC7139125 DOI: 10.1016/j.ijscr.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION With the rising burden of obesity, bariatric surgery is becoming more common as a treatment option. Laparoscopic adjustable gastric banding (LAGB) is considered safe and effective and is a popular procedure in Australia. However there are recognised complications to be aware of such as band erosion which can lead to infection and abscess formation. PRESENTATION OF CASE A 59-year-old caucasian female presented with fevers, rigors and feeling generally unwell. She was previously fit and well with her only past medical history being LAGB 14 years prior. Clinically the patient was in septic shock and required intensive care admission for inotropic support. On investigations the CRP was 227 and abdominal computed tomography (CT) revealed a splenic abscess. Follow up upper gastrointestinal endoscopy diagnosed an eroded gastric band in the stomach. The patient proceeded to laparoscopy, a gastrotomy was performed and the band was removed. The splenic abscess was concurrently drained and the patient treated with an extended course of intravenous and oral antibiotics. DISCUSSION Band erosion is a rare but serious complications of LAGB surgery along with band slippage, pouch dilatation and abscess formation. Patients are often asymptomatic making early diagnosis difficult. Upper gastrointestinal endoscopy is used to locate the band and recommended treatment is band removal via laparoscopy or laparotomy. CONCLUSION Band erosion should be suspected in patients with a history of LAGB presenting with nonspecific symptoms such as abdominal pain or fevers. This case also highlights the importance of appropriate patient follow up post operatively and counselling of operative risks and long-term complications.
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Affiliation(s)
- Victoria Lu
- Upper Gastro-intestinal Surgical Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Harsh Kanhere
- Upper Gastro-intestinal Surgical Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Cho EJ, Kim SM. Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center. Yonsei Med J 2019; 60:782-790. [PMID: 31347334 PMCID: PMC6660444 DOI: 10.3349/ymj.2019.60.8.782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/05/2019] [Accepted: 06/04/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation. MATERIALS AND METHODS This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities. RESULTS Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal. CONCLUSION During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.
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Affiliation(s)
- Eun Jung Cho
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Hassan TM, Ontiveros E, Davis D, Leeds SG. Endoscopic Removal of Noneroded Nonadjustable Gastric Bands Using Induced Mucosal Erosion With a Stent, and Review of the Literature. Surg Innov 2018; 26:162-167. [DOI: 10.1177/1553350618820377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Laparoscopic removal of noneroded nonadjustable gastric bands (NAGBs) may lead to major life-threatening complications. A minimally invasive approach involving endoscopic removal by induced mucosal erosion with a stent (IMES) has been used in a few publications to remove NAGBs. Objective. To examine a minimally invasive endoscopic approach to removal of a NAGB. Setting. A large tertiary/quaternary referral hospital. Methods. We report 4 patients that underwent IMES at our institution and present a literature review of published cases. The procedure includes using an endoscopically placed fully covered stent through the NAGB stricture to cause erosion of the mucosa where the stent is putting direct pressure. After a predetermined length of time, the stent is removed with the NAGB and without a laparoscopic or open procedure. Primary endpoint for our cohort was successful removal to the NAGB with IMES. Secondary endpoints included interval of time to retrieval of the stent, complications from IMES, presenting symptoms, and type of NAGB. These endpoints were then compared with previous publications indicating the use of IMES. Results. Three of 4 patients were female with a mean age of 64.5 years. All patients had the NAGB successfully removed with IMES. The mean time for NAGB and stent removal after insertion was 17.5 days. No major complications were noted. Two patients had post-IMES strictures and were managed by balloon dilation. Conclusion. Endoscopic removal of NAGBs is a safe and feasible procedure for NAGB removal and can be used in place of laparoscopic surgery.
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Affiliation(s)
- Tareq M. Hassan
- Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, USA
- Baylor University Medical Center at Dallas, TX, USA
| | - Estrellita Ontiveros
- Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, USA
- Baylor University Medical Center at Dallas, TX, USA
| | - Daniel Davis
- Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, USA
- Baylor University Medical Center at Dallas, TX, USA
| | - Steven G. Leeds
- Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, USA
- Baylor University Medical Center at Dallas, TX, USA
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Cho EJ, Kim SM. Revisional surgery after removal of eroded adjustable gastric bands. Asian J Surg 2018; 42:688-695. [PMID: 30477925 DOI: 10.1016/j.asjsur.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of the study is to present surgical techniques and treatment outcomes for re-banding and sleeve gastrectomy as a revisional surgery after removing eroded adjustable gastric bands. METHODS A retrospective analysis was performed to study laparoscopic re-banding or sleeve gastrectomy as revisional surgery for band erosion. Main outcome measures were success of therapeutic strategies, morbidity, body mass index, and percentage total excess weight loss before and after revision. RESULTS From March 2013 to June 2017, a total of 11 patients underwent the revisional surgery. Six patients underwent sleeve gastrectomy at median 15.7 months (13.2-73.3 months) after band removal, and 5 patients gastric re-banding at median 5.4 months (3.1-43.8 months). One of the six patients that underwent sleeve gastrectomy was diagnosed to have a minor leak. No other critical postoperative complication was observed in each group. Median BMI at revision in the sleeve gastrectomy group was 32.7 kg/m2 (31.2-40.8 kg/m2). Median follow-up after revision was 33.8 months (15.5-63.7 months), and at last follow-up, median BMI was 26.4 kg/m2 (23.6-34.6 kg/m2), and median %TWL was 17.6% (9.5-31.5%). In the rebanding group, median BMI at revision was 30.7 kg/m2 (27.0-41.4 kg/m2). Median follow-up after revision was 25.5 months (13.5-45.4 months), and at last follow-up, median BMI was 23.5 kg/m2 (22.0-30.1 kg/m2) and median %TWL was 23.9% (9.1-29.0%). CONCLUSION Given the surgical techniques adopted, both re-banding and sleeve gastrectomy were found to be safe and effective revisional surgery after removal of eroded gastric band.
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Affiliation(s)
- Eun Jung Cho
- Department of Surgery, Gachon University Gil Hospital, Gachon University of College Medicine, Incheon, South Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Hospital, Gachon University of College Medicine, Incheon, South Korea.
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Abstract
BACKGROUND Banded-gastric bypass is a highly effective bariatric procedure, yet the possibility of band erosion remains a significant drawback. Surgical removal of eroded bands may be associated with significant morbidity. In this study, we assess the efficacy and safety of a solely peroral endoscopic approach for the management of eroded bands in patients with a banded-gastric bypass. MATERIALS AND METHODS Starting January 2012, all patients with banded-gastric bypass and an eroded band were subjected to an attempt at peroral endoscopic removal using endoscopic scissors and/or argon plasma coagulation (APC), regardless of the circumference of band eroding inside the lumen. RESULTS Sixteen patients presented with eroded bands, 2 were deemed not amenable to endoscopic removal as only part of the thickness was eroded. Of the 14 patients where endoscopic attempts were performed, 12 (86%) were completely removed successfully, while 2 (14%) were cut but could not be extracted and only the intraluminal portion was trimmed. Complete resolution of symptoms occurred in 13 (93%) while in 1 patient (7%) there was partial improvement. Only one endoscopic session was performed per patient with a median time of 37.5 min per session (22-55 min). No complications were encountered. CONCLUSION Endoscopic removal of eroded gastric bands in patients with banded-gastric bypass is effective and safe in the majority of patients. When bands are adherent to the gastric wall, removal of the intraluminal portion of the band may lead to full or partial improvement of symptoms. Endoscopic band removal can be attempted even when a small part of band circumference has eroded.
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Kim SB, Kim SM. Short-Term Analysis of Food Tolerance and Quality of Life after Laparoscopic Greater Curvature Plication. Yonsei Med J 2016; 57:430-40. [PMID: 26847297 PMCID: PMC4740537 DOI: 10.3349/ymj.2016.57.2.430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 06/19/2015] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The aim of this study was to compare short-term outcomes [food tolerance scores (FTS) and quality of life] after three types of restrictive bariatric surgery: laparoscopic adjustable gastric banding (LAGB), laparoscopic greater curvature plication (LGCP), and laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS From January 2012 to December 2013, all patients that underwent primary surgery were included in one of the LAGB, LGCP, or LSG groups. These three groups were then compared with respect to FTS, gastrointestinal quality of life indices (GIQLI), and the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire. Questionnaires were sent to all patients both pre- and post-operatively. RESULTS A total of 85 patients (LAGB=45, LGCP=22, and LSG=18) returned the questionnaires in full, and these patients constituted the study cohort. The cohort was predominately female (n=73, 85.9%). Mean percentage excess weight loss (%EWL) values after LAGB, LGCP, and LSG were 65.4 ± 27.0%, 65.6 ± 25.2%, and 82.7 ± 21.7%, respectively (p=0.044). Mean postoperative FTSs and improvements in total GIQLIs after LAGB, LGCP, and LSG were 15.96, 20.95, and 21.33 and -3.40, 6.68, and 18.78, respectively (p<0.05). All procedures produced improvements in the three SF-36 domain scores. Subgroup analysis revealed significant differences between the three procedures in terms of improvements in general health and emotional well-being. CONCLUSION LGCP is safe and effective at achieving significant weight loss. In terms of food tolerance and GI quality of life, LGCP was found to be comparable to gastric banding and sleeve gastrectomy.
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Affiliation(s)
- Su Bin Kim
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
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An 8-Year Experience With Endoscopic Management of Eroded Gastric Bands. Surg Laparosc Endosc Percutan Tech 2015; 25:e140-4. [DOI: 10.1097/sle.0000000000000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simultaneous Gastric and Duodenal Erosions due to Adjustable Gastric Banding for Morbid Obesity. Case Rep Surg 2014; 2014:146980. [PMID: 24883218 PMCID: PMC4026868 DOI: 10.1155/2014/146980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/26/2014] [Indexed: 11/17/2022] Open
Abstract
Erosion is an uncommon but feared late complication of adjustable gastric banding for morbid obesity. A high index of clinical suspicion is required, since symptoms are usually vague and nonspecific. Diagnosis is confirmed on upper gastrointestinal endoscopy and band removal is the mainstay of treatment, with band revision or conversion to other bariatric modalities at a later stage. Duodenal erosion is a much rarer complication, caused by the connection tubing of the band. We present our experience with a case of simultaneous gastric and duodenal erosions, managed by laparoscopic explantation of the band, primary suture repair of the duodenum, and omentopexy.
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Dogan ÜB, Akin MS, Yalaki S, Akova A, Yilmaz C. Endoscopic management of gastric band erosions: a 7-year series of 14 patients. Can J Surg 2014; 57:106-11. [PMID: 24666448 DOI: 10.1503/cjs.001313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. METHODS We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter. RESULTS Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric penetration of the connecting tube broken close to the band. CONCLUSION The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.
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Affiliation(s)
- Ümit Bilge Dogan
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Salih Akin
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Serkan Yalaki
- The Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Atilla Akova
- The Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cengiz Yilmaz
- The Department of Radiology, Adana Numune Training and Research Hospital, Adana, Turkey
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Abstract
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.
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Affiliation(s)
- Woon Ki Lee
- Department of Surgery, Gil Medical Center, Gachon University of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea.
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Blouhos K, Boulas KA, Katsaouni SP, Salpigktidis II, Mauroeidi B, Ioannidis K, Hatzigeorgiadis A. Connecting tube colonic erosion and gastrocolic fistula formation following late gastric band erosion. Clin Obes 2013; 3:158-61. [PMID: 25586631 DOI: 10.1111/cob.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/10/2013] [Accepted: 06/02/2013] [Indexed: 12/23/2022]
Abstract
Band erosion is a rare complication of laparoscopic adjustable gastric banding (LAGB) with a reported prevalence varying from 0.3% to 14%. Intraluminal colonic erosion of the connecting tube is very rare, as only isolated cases have been described. Consequently, simultaneous gastric band erosion and connecting tube colonic erosion is an extremely rare event. Herein, we present a case of a woman with morbid obesity, who submitted to LABG 4 years ago. The patient presented with symptoms and signs of right lower quadrant peritonitis. Computed tomography (CT) demonstrated migration of the band into the gastric lumen, inflammation around the intra-abdominal course of the connecting tube and an inflammatory mass surrounding the tube at the right lower quadrant. Laparotomy revealed the eroded band, the eroded transverse colon from the connecting tube, a gastrocolic fistula along the course of the tube and a right lower quadrant phlegmon. The connecting tube was mobilized from the surrounding adherent tissues, the gastric band removed, the stomach and colon walls closed, and the gastrocolic fistula excised. To our knowledge this is the second case of concurrent band erosion and connecting tube colonic erosion along with gastrocolic fistula formation in a patient with morbid obesity treated with LAGB.
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Affiliation(s)
- K Blouhos
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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