Skip to main content

Advertisement

SpringerLink
Log in

Bariatric Emergencies for Non-Bariatric Surgeons: Complications of Laparoscopic Gastric Banding

  • Clinical Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) has gained popularity for treatment of morbid obesity worldwide. With the widespread use of LAGB, an increasing number of medical specialists are dealing with the potentially life-threatening complications of this procedure.

Methods

More than 6,000 LABGs were performed by our surgeons during the past 11 years, during which various complications of LAGB were observed, including band slippage, erosion, gastric pouch dilatation, port infection, and disconnection. Complicated cases requiring emergency surgical intervention were collected. We present and discuss the diagnostic and therapeutic possibilities of these complications.

Results

Fourteen cases were identified: six with acute band slippage, two with small bowel obstruction, and one each with band slippage and fetal intrauterine growth restriction during the 36th week of pregnancy, perforated gastric ulcer, upper gastrointestinal bleeding, connecting tube penetration into a stomach ulcer, connecting tube penetration into the colon, and port disconnection. All patients had gastrointestinal symptoms at admission. Band reposition was performed in four cases; eight patients required band removal for band contamination. The band was open and still in place in one case. Open and laparoscopic gastric resections for necrotic stomach were performed in two cases. Suture of perforated gastric ulcer was combined with cesarean section. Connection of disconnected port and suture of colonic and gastric penetrations and perforation of fundus were completed laparoscopically. Small bowel resection and enterotomy required an additional minimal laparotomic incision. No mortality was observed in our series. Four patients elected to have the LAGB reinserted at a later time.

Conclusion

The increasing number of bariatric procedures has resulted in emergency physicians' knowledge of serious complications of LAGB that require urgent surgical intervention. Treatment algorithms require early diagnosis and a surgical approach to solving these conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16(7):829–35.

    Article  CAS  PubMed  Google Scholar 

  2. Steffen R, Biertho L, Ricklin T, et al. Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg. 2003;13(3):404–11.

    Article  PubMed  Google Scholar 

  3. Weiss HG, Kirchmayr W, Klaus A, et al. Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg. 2004;91(2):235–41.

    Article  CAS  PubMed  Google Scholar 

  4. Brown WA, Burton PR, Anderson M, et al. Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management. Obes Surg. 2008;18(9):1104–8.

    Article  PubMed  Google Scholar 

  5. Bueter M, Thalheimer A, Meyer D, et al. Band erosion and passage, causing small bowel obstruction. Obes Surg. 2006;16(12):1679–82.

    Article  PubMed  Google Scholar 

  6. Lantsberg L, Kirshtein B, Leytzin A, et al. Jejunal obstruction caused by migrated gastric band. Obes Surg. 2008;18(2):225–7.

    Article  PubMed  Google Scholar 

  7. Zappa MA, Lattuada E, Mozzi E, et al. An unusual complication of gastric banding: recurrent small bowel obstruction caused by the connecting tube. Obes Surg. 2006;16(7):939–41.

    Article  CAS  PubMed  Google Scholar 

  8. Rao A, Ramalingam DG. Exsanguinating hemorrhage following gastric erosion after laparoscopic adjustable gastric banding. Obes Surg. 2006;16(12):1675–8.

    Article  PubMed  Google Scholar 

  9. Iqbal M, Manjunath S, Seenath M, et al. Massive upper gastrointestinal hemorrhage: an unusual presentation after laparoscopic adjustable gastric banding due to erosion into the celiac axis. Obes Surg. 2008;18(6):759–60.

    Article  PubMed  Google Scholar 

  10. Yoffe B, Sapojnikov S, Goldblum C. Gastric wall necrosis following late prolapse after laparoscopic banding. Obes Surg. 2004;14(1):142–4.

    Article  PubMed  Google Scholar 

  11. Iannelli A, Facchiano E, Sejor E, et al. Gastric necrosis: a rare complication of gastric banding. Obes Surg. 2005;15(8):1211–4.

    Article  PubMed  Google Scholar 

  12. Hartmann J, Scharfenberg M, Paul M, et al. Intracolonic penetration of the laparoscopic adjustable gastric banding tube. Obes Surg. 2006;16(2):203–5.

    Article  PubMed  Google Scholar 

  13. Zengin K, Sen B, Ozben V, et al. Detachment of the connecting tube from the port and migration into jejunal wall. Obes Surg. 2006;16(2):206–7.

    Article  PubMed  Google Scholar 

  14. Balsiger BM, Ernst D, Giachino D, et al. Prospective evaluation and 7-year follow-up of Swedish adjustable gastric banding in adults with extreme obesity. J Gastrointest Surg. 2007;11(11):1470–6. discussion 1446–7.

    Article  PubMed  Google Scholar 

  15. Boschi S, Fogli L, Berta RD, et al. Avoiding complications after laparoscopic esophago-gastric banding: experience with 400 consecutive patients. Obes Surg. 2006;16(9):1166–70.

    Article  PubMed  Google Scholar 

  16. Singhal R, Kitchen M, Ndirika S, et al. The "Birmingham stitch"–avoiding slippage in laparoscopic gastric banding. Obes Surg. 2008;18(4):359–63.

    Article  PubMed  Google Scholar 

  17. Busetto L, Segato G, De Marchi F, et al. Postoperative management of laparoscopic gastric banding. Obes Surg. 2003;13(1):121–7.

    Article  PubMed  Google Scholar 

  18. Rizzo AG. Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech A. 2003;13(1):11–5.

    Article  PubMed  Google Scholar 

  19. Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc. 2004;18(2):237–41.

    Article  CAS  PubMed  Google Scholar 

  20. Lunca S, Vix M, Rikkers A, et al. Late gastric prolapse with pouch necrosis after laparoscopic adjustable gastric banding. Obes Surg. 2005;15(4):571–5.

    Article  PubMed  Google Scholar 

  21. Pinsk I, Dukhno O, Levy I, et al. Gastric outlet obstruction caused by total band erosion. Obes Surg. 2004;14(9):1277–9.

    Article  PubMed  Google Scholar 

  22. Biertho L, Steffen R, Branson R, et al. Management of failed adjustable gastric banding. Surgery. 2005;137(1):33–41.

    Article  PubMed  Google Scholar 

  23. Bueter M, Thalheimer A, Wierlemann A, et al. Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc. 2009;23(2):334–40.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva, 84101, Israel

    Boris Kirshtein, Leonid Lantsberg, Solly Mizrahi & Eliezer Avinoach

Authors
  1. Boris Kirshtein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonid Lantsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Solly Mizrahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eliezer Avinoach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Boris Kirshtein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirshtein, B., Lantsberg, L., Mizrahi, S. et al. Bariatric Emergencies for Non-Bariatric Surgeons: Complications of Laparoscopic Gastric Banding. OBES SURG 20, 1468–1478 (2010). https://doi.org/10.1007/s11695-009-0059-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-0059-5

Keywords

Search

Navigation