Intragastric erosion of laparoscopic adjustable silicone gastric band

Erosions after laparoscopic adjustable gastric banding: diagnosis and management

OBJECTIVE

To define the changing prevalence of erosion after Laparoscopic Adjustable Gastric Banding (LAGB), describing the range of clinical presentations, the approaches to treatment and the outcomes from these approaches over a 15-year study period.

BACKGROUND

A recent systematic review of the literature of erosion after LAGB identified 25 relevant studies and reported a total of 231 erosions in 15,775 patients giving an overall incidence of 1.46%. The review highlighted a broad variation of incidence from 0.2% to 33%. The review was unable to identify either common presentations or an optimal pattern of management.

METHODS

Patients who underwent a primary LAGB operation between September 1994 and January 2010 by 2 surgeons (P.O.B. and W.B.) were identified in a prospectively maintained database. Those patients who had an erosion of their LAGB were identified. Presentation, operative details, demographics, body mass index, weight history, and perioperative problems were analyzed.

RESULTS

In total, 2986 patients were identified. All bands placed were Lap-Bands (Allergan, CA). Hundred erosions were experienced by 85 patients (2.85%) at a median time of 33 months from initial surgery to the erosion (range: 11-170 months). The rate of erosion was highest when the band was placed by the perigastric approach at 6.77%. Since the adoption of the pars flaccida approach, the rate of erosion has dropped to 1.07%. The majority of patients who had experienced an erosion (71 patients; 83.5%) experienced only 1 erosion, 13 patients (15.3%) had 2 erosions, and 1 patient had 3 erosions. The most common presentation was loss of satiety. The band has been successfully replaced in 56 patients. It has been explanted in 27 patients and 2 patients were converted to other bariatric procedures. The weight loss in patients who had a LAGB reinserted after erosion was not significantly different to the background cohort.

CONCLUSIONS

Erosion of LAGB is uncommon and its clinical course is benign. It is best treated with a staged surgical approach; initially, with removal and repair followed later by replacement. With this approach, weight loss is maintained and reerosion is uncommon.

Experiences of two centers of bariatric surgery in the treatment of intragastrale band migration after gastric banding-the importance of the German multicenter observational study for quality assurance in obesity surgery 2005 and 2006

BACKGROUND

Adjustable silicone gastric banding (ASGB) is an effective treatment in morbid obesity. Band migration is a long-term complication. Causes, clinical symptoms, timing and incidence are investigated in single centres only. In Germany, since January 1st, 2005, practice in bariatric surgery has been investigated in German prospective multicenter trial for quality assurance in obesity surgery.

MATERIALS AND METHODS

All patients underwent ASGB in two centres of bariatric surgery in Germany were prospectively registered using a computer-based data form. Patients with band migration were retrospectively evaluated, in particular, causes and characteristics of its management. The results were correlated with data obtained from the German prospective multicentre trial.

RESULTS

In total, 493 patients were enrolled in the study from February 1995 to February 2007. The follow-up rate was 79.9% (mean follow-up time period, 78.7 months; range, 2-148 months). Fifteen patients (3.0%) developed migration. In 14 cases, migration occurred within the range of 30-86 months after implantation. In one case, migration occurred 10 months after repositioning of the band. In the German multicentre trial, 629 patients underwent surgery during 2005 and 827 patients in 2006. In both periods, 74.4% of the patients were female and 25.6% male. The most frequently performed operation was ASGB (46.8%) followed by Roux-en-Y gastric bypass (38.5%).

CONCLUSION

Band migration requires band removal. Different symptoms and complications influence the kind of band removal. Multicentre data were evident in the case of high long-term complication rate after ASGB. Data of the German multicentre trial show the trend from restrictive bariatric procedures to malabsorptive approach.

Hypovolemic shock due to intragastric migration of an adjustable gastric band

Migration of the adjustable gastric band (AGB) is a serious complication which usually does not require emergency treatment, except when there is a risk to life. We report a 30-year-old patient who presented with syncope, melena and hypovolemic shock due to the intragastric erosion of an AGB, 13 months after laparoscopic band placement. The diagnosis of migration had been made 7 months after placement, and bleeding only occurred 6 months later. Greater intraluminal penetration had been awaited to facilitate gastroscopic extraction, but, faced with hemodynamic instability, resuscitation was carried out followed by emergency endoscopy to cut the device, using endoscopic scissors. Then, the band was removed orally. There has been no recurrence of hemorrhage 12 months later. Delayed treatment may be indicated in cases of initial band migration; however, rigorous follow-up is necessary with frequent re-evaluation, to diagnose potentially life-threatening complications promptly.

[Band migration. A late complication of gastric banding]

BACKGROUND

Adjustable silicone gastric banding is an effective and safe treatment for morbid obesity. Migration of the band through the stomach wall is a long-term complication. The causes, clinical symptoms, timing, and incidence of band migration have not yet been investigated.

METHODS

We report our experience over 9 years. Between February 1995 and February 2004, we performed adjustable silicone gastric banding in 161 patients, with follow-up of about 90.5% of cases. Mean follow-up time was 60.4 months. Cases of erosion were studied retrospectively.

RESULTS

Eight patients (4.9%) developed band migration. In seven, the migration occurred between 30 and 86 months after band implantation. In one case, the migration occurred 10 months after laparoscopic repositioning of the band to avoid pouch dilatation. In all cases, the bands were removed.

CONCLUSION

Band migration is a late complication after gastric banding that requires band removal. Various symptoms and complications of band migration influence the kind of band removal. The causes of band migration and its treatment are discussed.

Laparoscopic adjustable gastric banding for the treatment of morbid obesity

BACKGROUND

This prospective study evaluated the effectiveness and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity.

METHODS

Ninety-five consecutive patients (89 female; median age 38 years, range 19 to 69) underwent LAGB for morbid obesity. Median weight and body mass index were 123.2 (88.9 to 228.6) kg and 45 (32.7-76.4) kg/m(2) respectively. Significant coexistent disease was present in 52 (55%) patients.

RESULTS

Median excess weight loss was 53% (range 96.9% to 12.1%) and 62% (range 107.5% to 32.3%) at 1 and 2 years respectively (P <0.001). Median operative time was 90 (range 35 to 285) minutes and inpatient stay 2 (range 1 to 10) days. Early complications were seen in 17 (18%) patients most commonly nausea/vomiting or dysphagia. Late complications were seen in 25 (26.3%) patients, most frequently vomiting or reflux due to band slippage or pouch dilatation. There was 1 (1%) operative death.

CONCLUSIONS

LAGB is an effective operation for morbid obesity that results in equivalent weight loss to open surgical procedures.

Laparoscopic adjustable silicone gastric banding: prospective evaluation of intragastric migration of the lap-band

Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.