J Korean Surg Soc.  2012 Jan;82(1):18-27. 10.4174/jkss.2012.82.1.18.

Early experience with diagnosis and management of eroded gastric bands

Affiliations
  • 1Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
  • 2Department of Surgery, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea. seongmin_kim@gilhospital.com

Abstract

PURPOSE
Band erosion is a well-known complication of laparoscopic adjustable gastric band placement. We gained experience with laparoscopic removal of an eroded gastric band.
METHODS
We retrospectively reviewed the operative log of our obesity surgery unit to identify all operations performed for band erosion from March 2009 to May 2011.
RESULTS
During the study period, a total of six of 96 patients (6.3%), five females and one male, were diagnosed with band erosion and underwent surgical removal of the band system. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 8.5 months (range, 7 to 22 months), with most band erosion occurring within the first year (5/6, 83%). The median body mass index at band removal was 28.4 kg/m2. Upper abdominal pain was the most common symptom (5/6, 83%), and other signs and symptoms were port site infection (3/6, 50%) and loss of restriction and weight regain (1/6, 17%). All eroded bands were removed using laparoscopy. Further complications after laparoscopic removal of the band system were observed in three cases. One patient showed multiple intra-abdominal abscesses requiring insertion of a pigtail catheter for drainage. The other two patients experienced sepsis with localized peritonitis, eventually requiring laparoscopic washout and drainage.
CONCLUSION
Gastric band erosion requires the removal of the gastric band. Laparoscopic removal is technically achievable in the majority of patients with eroded gastric band. The method can be challenging, has potential postoperative complications (fistula, abscess), and should be attempted only by experienced surgeons.

Keyword

Gastric banding; Bariatric surgery; Band erosion; Morbid obesity; Complications

MeSH Terms

Abdominal Abscess
Abdominal Pain
Bariatric Surgery
Body Mass Index
Catheters
Cytochrome P-450 CYP1A1
Drainage
Female
Humans
Laparoscopy
Male
Obesity
Obesity, Morbid
Peritonitis
Postoperative Complications
Retrospective Studies
Sepsis
Cytochrome P-450 CYP1A1

Figure

  • Fig. 1 Flow chart showing the diagnosis procedure in patients with band erosion (BE). UGI, upper gastrointestinal; CT, computed tomography; EGD, esophagogastroduodenoscopy.

  • Fig. 2 Location of band erosion on esophagogastroduodenoscopy. 1, anterosuperior; 2, posterosuperior; 3, anteroinferior; 4, posteroinferior.

  • Fig. 3 (A) Five days after band removal, the patient (#4) showed localized peritonitis in the right lower quadrant (RLQ) abdomen. Abdominal computed tomopgraphy (CT) scan showed multifocal, loculated, and encapsulated fluid collection in the RLQ (diameter: 6.5 cm) (arrow). (B) Third days after band removal, the patient (#6) showed a spiking fever, tachycardia, and left pleuritic chest pain. Abdominal CT scan showed a suspicious perigastric abscess near the suture line and loculated fluid collections or abscess indenting anterior surface of the left lateral segment of liver (long arrows). A closed-suction drain was located in the subhepatic space (short arrows).


Cited by  3 articles

Three-Year Experience of Pouch Dilatation and Slippage Management after Laparoscopic Adjustable Gastric Banding
Woon Ki Lee, Seong Min Kim
Yonsei Med J. 2014;55(1):149-156.    doi: 10.3349/ymj.2014.55.1.149.

Short-Term Analysis of Food Tolerance and Quality of Life after Laparoscopic Greater Curvature Plication
Su Bin Kim, Seong Min Kim
Yonsei Med J. 2016;57(2):430-440.    doi: 10.3349/ymj.2016.57.2.430.

Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center
Eun Jung Cho, Seong Min Kim
Yonsei Med J. 2019;60(8):782-790.    doi: 10.3349/ymj.2019.60.8.782.


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