Complications associated with Gastric banding A Surgeon's guide

[JACKIEO85 308]

Pouch enlargement

Pouch enlargement (type-III prolapse) is diagnosed when dilation of the proximal gastric pouch is present with or without change in the angle of the band and in the absence of signs of obstruction.

The lower esophagus may or may not be dilated. Pouch enlargement is a pressure-related phenomenon that may be surgically induced by band over inflation or overeating with resulting high pressure in the pouch.

Symptoms of pouch enlargement include lack of satiety, heartburn, regurgitation and occasional chest pain. The diagnosis is made with an upper gastrointestinal series

Nonoperative treatment includes complete band deflation, low-calorie diet, re-enforcement of portion size and follow-up contrast study in 4–6 weeks. If the band position and the pouch size return to normal, then the band can be incrementally re inflated. A study by Moser and colleagues demonstrated that this conservative approach to pouch enlargement was successful in up to 77% of patients. Conservative treatment is considered unsuccessful when the pouch fails to recover its original size after 8–10 weeks. In this circumstance, surgical treatment with either band removal or replacement is indicated.

Band slip

Band slip may be defined as cephalad prolapse of the body of the stomach or caudal movement of the band. Other published literature report an incidence of slip of 1%–22%.

Since the cross-sectional area of the stomach is larger at the body than at the level of the angle of His (normal band position), complete obstruction of the stomach can occur when the band slips. Band slip can be posterior or anterior, depending on whether the anterior or posterior region of the stomach herniates through the band.

Anterior slip (type-I prolapse)

Anterior slip results from upward migration of the anterior wall of the stomach through the band. This can be due to insufficient anterior fixation and disruption of the fixation sutures. The second cause may be related to increased pressure in the pouch due to early solid food, vomiting, overeating or early (< 4 wk) band fill.

Posterior slip (type-II prolapse)

Posterior slip is defined as a herniation of the posterior wall of the stomach through the band. This is usually related to the surgical technique but is less frequent now with adoption of the pars flaccida approach instead of the perigastric approach

In both types of slip, the patient usually presents with dysphagia, vomiting, regurgitation and food intolerance. The diagnosis is made by upper gastrointestinal series. Complications related to band slip include gastric perforation, necrosis of the slipped stomach (type-V prolapse), upper gastrointestinal bleeding and aspiration pneumonia.

Type-IV prolapse

A type-IV prolapse is defined as an immediate postoperative prolapse and is usually due to placing the band too low on the stomach.

Band slip types (I, II, IV and V) are acute and always require surgical intervention. Laparoscopic removal or repositioning of the band is the preferred method of treatment. Pouch enlargement is a chronic complication that should be managed nonoperatively in the first instance, and surgical readjustment is reserved only for those patients in whom conservative treatment fails.

Band erosion

Band erosion is an uncommon complication of LAGB. In this scenario, the band gradually erodes through the stomach wall and into the gastric lumen. The incidence is less than 1%, with a reported prevalence varying from 0% to 11%.

The etiology of band erosion may be the result of gastric-wall injury during band placement or tight anterior fixation, especially around the band buckle.

A high index of suspicion is required for diagnosis of band erosion as most patients are asymptomatic. When symptomatic, complaints related to erosion include loss of restriction, nonspecific epigastric pain, gastrointestinal bleeding, intra-abdominal abscesses or port-site infection. The diagnosis is often made at the time of gastroscopy.

The recommended treatment is complete removal of the eroded gastric band laparoscopically or via laparotomy.

Port-site infection

Port-site infections can be classified as early and late. Early infections will manifest with the cardinal signs of erythema, swelling and pain. These infections typically occur within the immediate postoperative period and may be reduced by the use of perioperative antibiotics. Early infection with cellulitis alone may be treated with oral antibiotics. If the response is inadequate, then intravenous antibiotic use is warranted. When the infection does not respond to intravenous antibiotics and is limited to the port, the port should be removed and the tubing knotted and left inside the abdomen. Once the local infection is resolved, a new port may be placed and tubing connected with laparoscopic guidance. Late port site infections are often caused by delayed band erosion with ascending infection. This usually manifests several months after surgery and can be associated with loss of restriction. These infections typically do not respond well to antibiotic treatment. If left undetected, band infection can evolve into potentially life-threatening intra-abdominal sepsis. Gastroscopy will confirm the diagnosis of band erosion. This complex clinical scenario is treated most expeditiously by removal of the band.

Port breakage

Breakage or damage of the port typically refers to leakage through a damaged port septum or tubing leading into the port. The use of a standard coring needle is strongly discouraged, and only Huber (noncoring) needles should be used to access the port. If port access is difficult or if the tubing connected to the port is at risk of perforation, then band adjustment under fluoroscopy is advised. Port breakage usually manifests as a slow leak with the loss of the injected Fluid volume on aspiration and the absence of restriction. It can be difficult to identify the leak site but local exploration of the port site can confirm the diagnosis.

I'm posting this because these are things we as Lap Band Patients should be aware of, I'm a firm believer of "Being forewarned is being Forearmed

[Baba Wawa 543]

When I got my band in 2010, these were listed as rare occurrences...now Lapband admits to 25% removal stat. Imagine what the true stats are!

[DELETE THIS ACCOUNT! 12,703]

Then you should be fair and also add that the majority of complications with the band are due to patient failure, not band failure.

And, that long term studies show success with the band. They also prove that when the patient follows the rules and does what they're supposed to, only 5% have to have their bands removed:

"The study, the longest and most comprehensive yet reported, appears in the Annals of Surgery, and finds a significant number of laparoscopic adjustable gastric banding (lap banding) patients maintained an average weight loss of 26 kilograms for more than a decade after their procedure.

Researchers analyzed the results in 3,227 patients who had gastric banding surgery in Australia between 1994, when the procedure was first introduced, and 2011. The patients in the study were averaged at 47 years-of-age and 78 percent were women.

Of those patients, 714 had surgery at least 10 years ago and, on average, had maintained a weight loss of 26 kilograms, or almost half of their excess weight.

The weight loss results were similar for the 54 patients in the study who had undergone treatment at least 15 years ago.

“These results show that when you have a significant problem with obesity, a long-term solution is available,” says Professor Paul O’Brien of the Centre for Obesity Research and Education at Monash University in Melbourne.

“This surgery is safe and effective, and it has lasting benefits. Substantial weight loss can change the lives of people who are obese—they can be healthier and live longer.”

O’Brien says there are also important ramifications for the control of type 2 diabetes, which was strongly associated with being overweight.

“In obese patients with type 2 diabetes, weight loss after gastric banding can lead to effective control of blood sugar levels without the need for medication in about three-quarters of cases,” O’Brien says.

The patients included in the study had followed the rules of their treating team regarding eating, exercise, and activity and committed to returning permanently to the aftercare program.

All the surgery was performed by O’Brien, an international pioneer of the technique, and Associate Professor Wendy Brown, President of the Obesity Surgery Society of Australia and New Zealand.

There were no deaths associated with the surgery or with any later operations that were needed in about half of the patients. About one in 20 patients had the band removed during the study period. (5%)

“In treating a chronic disease such as obesity over a lifetime, it is likely that something will need to be corrected at some time in some patients,” says O’Brien.

“The study shows a marked reduction of revisional procedures with the introduction of the new version of the Lap-Band 6 years ago. Importantly, those who had revisional surgery lost as much weight in the long term as those who did not need it.”

The report also included a comparison of gastric banding—which can be done as a day-surgery procedure—and more invasive types of weight-loss surgery such as gastric bypass that are high risk and require longer hospital stay. The weight loss with gastric banding, and the need for future revisional surgery, was similar to that with gastric bypass.

“Access to weight-loss surgery in Australia remains severely limited for many obese patients as relatively few cases are treated within the public health system. We are working hard to improve access,” says O’Brien.

“We have ample evidence that weight-loss surgery is effective, and it is unfair that half of eligible patients cannot be treated, particularly as it has been shown that gastric banding is a highly cost-effective health care measure. The stigma of obesity, and the assumption that it is the person’s fault, entrenches discrimination against people who could benefit.”

[JACKIEO85 308]

My Post was to INFORM anyone with a lap band of the possible complications/symptoms that they might experience. This was from the U.S. National Library of Medicine /National Institutes of Health A Surgeons guide as I stated.

I'm Not here To Band Bash, I have one, I just find that no matter where you go on the majority of WLS sites no one tells you about Complications, the majority of the information is anecdotal. the fact is most of the studies are funded by the manufacturer of the products so were not getting Unbiased information.

I prefer to believe in Education being Power and that leads to Empowerment of our own health NO ONE, is going to be an advocate for ME MORE THAN ME!

(your comment): Then you should be fair and also add that the majority of complications with the band are due to patient failure, not band failure.

I'd be curious as to HOW you came to this conclusion? Scar tissue from LB surgery isn't a patient's fault, yes some things like non-compliance is a patient's fault but to make a BLANKET statement like it's the patient's fault if the band fails is LIDICUOUS, and detrimental to people looking for the FACTS about a LB

[DELETE THIS ACCOUNT! 12,703]

My Post was to INFORM anyone with a lap band of the possible complications/symptoms that they might experience. This was from the U.S. National Library of Medicine /National Institutes of Health A Surgeons guide as I stated.

I'm Not here To Band Bash, I have one, I just find that no matter where you go on the majority of WLS sites no one tells you about Complications, the majority of the information is anecdotal. the fact is most of the studies are funded by the manufacturer of the products so were not getting Unbiased information.

I prefer to believe in Education being Power and that leads to Empowerment of our own health NO ONE, is going to be an advocate for ME MORE THAN ME!

(your comment): Then you should be fair and also add that the majority of complications with the band are due to patient failure, not band failure.

I'd be curious as to HOW you came to this conclusion? Scar tissue from LB surgery isn't a patient's fault, yes some things like non-compliance is a patient's fault but to make a BLANKET statement like it's the patient's fault if the band fails is LIDICUOUS, and detrimental to people looking for the FACTS about a LB

I didn't come to that conclusion, Dr. Obrien who did the study on over 3000 Lap Band patients over a 15 year time period did.

It's not my opinion, it's fact that's based on an actual clinical study. Only 5% of Lap Band patients have complications resulting in band removal by no fault of their own.

[JACKIEO85 308]

OK perhaps you missed the point, I don't dispute the failure rates, what I was disputing was your comment:

(your comment): Then you should be fair and also add that the majority of complications with the band are due to patient failure, not band failure.

according to what you wrote and I read it to say was that your blaming patient's for the failure of their bands? Because that I don't believe to be true, not until I see the results from a study telling me about all the complications,

[Terry Poperszky 2,784]

but to make a BLANKET statement like it's the patient's fault if the band fails is LIDICUOUS, and detrimental to people looking for the FACTS about a LB

Hmm... I read Missy's post and I don't find that statement anywhere. Most doesn't equal all, and is detrimental to people looking for the "FACTS". BTW, my surgeon gave me a complete list of the complications, alone with stats for other centers of excellence as well as his own stats (good and bad).

[DELETE THIS ACCOUNT! 12,703]

OK perhaps you missed the point, I don't dispute the failure rates, what I was disputing was your comment:

(your comment): Then you should be fair and also add that the majority of complications with the band are due to patient failure, not band failure.

according to what you wrote and I read it to say was that your blaming patient's for the failure of their bands? Because that I don't believe to be true, not until I see the results from a study telling me about all the complications,

Well when only 5% are having serious complications when following the rules, then yes the rest that don't follow the rules and have complications have no one to blame but themselves.

It's called accountability. If you don't follow the rules and have complications because of it, the fault is your own.

[Terry Poperszky 2,784]

When I got my band in 2010, these were listed as rare occurrences...now Lapband admits to 25% removal stat. Imagine what the true stats are!

Ms. Maui, let's be fair. That stat was true of the older lap bands wasn't it? And while you are at it, can you tell me what the reversal rates are for Gastric Bypass and Gastric Sleeves? Oh, wait they can't be reversed can they?

And as long as you are interested in stats, would you care to let us know what the mortality rates are between the different types of bariatric surgery? Any bets which surgery has fewer patients die within 30 days of the surgery?

Now, I don't have an axe to grind, and even if what you said was actually true of the lap band that I had installed, I would still have gone ahead with the surgery. I like choice in my life, and with the lap band I have a choice. With GB and sleeve, there is not going back, no further choice.

Now, with that said, if my band fails and they can't put another band in. I will probably revise to a sleeve, if that fails (they do), I will opt for something else. But you see as a band patient, i have that choice. My friends wife who had GB and makes her self sick 4-5 times a week with dumping, doesn't have a choice anymore.

http://www.obesitylapbandsurgery.com/statmain.html

Edited March 17, 2013 by Terry Poperszky

[Baba Wawa 543]

Terry, that stat is currently on the Lapband website. Not made up.

[Terry Poperszky 2,784]

Terry, that stat is currently on the Lapband website. Not made up.

Please re-read what I said. What I didn't say was that you made the figure up. Please I offend enough people as it is without putting words in my mouth

I said that the 25% figure concerning the older bands, and not the newer ones. If that isn't true, then I am mistaken. If it is true then what you said misrepresents today's lapband surgery success rates (and are mistaken). In reality, until one of us links to a study that supports our statements, then we are BOTH simply passing along hearsay.

[Baba Wawa 543]

Please re-read what I said. What I didn't say was that you made the figure up. Please I offend enough people as it is without putting words in my mouth

I said that the 25% figure concerning the older bands, and not the newer ones. If that isn't true, then I am mistaken. If it is true then what you said misrepresents today's lapband surgery success rates (and are mistaken). In reality, until one of us links to a study that supports our statements, then we are BOTH simply passing along hearsay.

Sorry, I didn't mean to put words in your mouth. Just having a rough day

[Terry Poperszky 2,784]

Sorry, I didn't mean to put words in your mouth. Just having a rough day

Been there, done that which is why I put the smiley face there. No hard feelings and I hope your day gets better.

[elcee 3,341]

What was the point of the OP starting this thread? Yes we are all aware of potential complications , most are rare, a lot are due to patient non compliance and most are not that serious. If my band slips so what, I can get it fixed etc .

How about someone starts a thread on complications associated with obesity.

[JACKIEO85 308]

The point was the NOT EVERYONE knows about the RARE complications, and since I now know that a lot are due to patient's non compliance,NOT band failure, or those rare complications, I'll just tell everyone that wants to Know about having a LB to GO GET ONE if you need to have surgery because of a slip HEY, no problem, it's not like it's major suregery. And all your health problems from being obese will go away with that LB.

Sorry I posted INFORMATION it won't happen again .