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Lap-Band erosion is migration of the band through the stomach wall into the stomach. This complication occurs in less than 2% of patients when surgeons use present day technique (pars flacida technique). It was significantly more common early on when the band was placed tightly against the stomach (peri-gastric technique).
Presentation. When the band erodes into the stomach, bacteria from the stomach enter into the capsule that mutually forms around the band. The infection then travels along the tubing into the pocket around the subcutaneous port. Thus many patients who develop erosion first notice pain, redness, and swelling in the vicinity of the access port. Another way that band migration presents is with loss of the band's restrictive effect. When the band erodes well into the stomach, food can bypass around the band. The patient can eat much more than before.
Diagnosis. Band erosion is best diagnosed with upper GI endoscopy. The endoscopist can actually see the band as it penetrates the stomach wall. IAn eroded band can also occasionally be identified on CT scan.
Treatment. Lap band erosion is usually not an emergency. If the access port site is infected, the port must be removed promptly. The band can then be removed semi- electively. Removal of an eroded band can be a difficult procedure requiring an open approach. Most surgeons simply remove the band and then perform rebanding, a gastric bypass, or duodenal switch as second procedure. Some surgeons have had success removing the band and performing a simultaneous rebanding or gastric bypass.
Image from: www.lap-surgery.com/images/gastric_band_comp05.jpg
Treatment of intra-gastric band migration following laparoscopic banding: safety and feasibility of simultaneous laparoscopic band removal and replacement.
Abu-Abeid S, et al.
Department of Surgery B and the Advanced Endoscopic Surgery Service, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
BACKGROUND: Intra-gastric band migration (band erosion) following laparoscopic adjustable gastric banding (LAGB) is a known complication requiring revisional surgery. Management has most often involved band removal and suturing of the stomach wall, followed by delayed replacement at a third operation. We report our experience with simultaneous band removal and replacement. METHODS: Between May 2001 and December 2003, we performed 754 laparoscopic operations using the Lap-Band (R). Patients developing band erosion were treated by laparoscopic band removal and immediate replacement of a new band following gastric wall repair. RESULTS: 16 patients (2.1%) developed band erosion after a mean of 23 months following surgery (range 11-40 months). Patients presented with epigastric pain (6), port-site bulge (3) or were asymptomatic (7), band erosion being suspected during fluoroscopy for band adjustment and confirmed by gastroscopy. Postoperatively, 11 patients developed fever that responded to antibiotics. No patient suffered from intra-abdominal infection, wound infection, pneumonia or pulmonary embolism. Mean hospital stay was 4 days (range 1-8 days). CONCLUSION: Band erosion following LAGB can be treated safely with simultaneous laparoscopic band removal, gastric wall suturing and immediate replacement of the band, thereby preventing weight gain, the appearance of co-morbidities and the need for additional surgery.
Obes Surg. 2005 Jun-Jul;15(6):849-52.
Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass.
* Suter M, et al.
Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
BACKGROUND: Laparoscopic adjustable gastric banding is a popular bariatric operation. Unfortunately, long-term complications such as slippage, infection, and intragastric migration (erosion) may occur. With erosion, band removal is mandatory. Options to prevent weight regain are delayed implantation of a new band, or conversion to another bariatric procedure such as Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion. We present our experience with band erosion and immediate or delayed conversion to RYGBP. METHODS: With a multidisciplinary team approach and prospective data collection, a comparison was made between patients with and without band erosion. The patients who were converted to RYGBP for band erosion were analyzed. RESULTS: Gastric banding was performed on 347 patients between 1995 and 2002. Median follow-up is 52 months. Band erosion developed in 24 patients (6.8 %).The latter were heavier before gastric banding (BMI 45.9 vs 43.3, P <0,01). No band had ever been overinflated. Band erosion was diagnosed after a mean of 22.5 months (3-51). At time of diagnosis, mean BMI of 33.5 kg/m(2) (22.5-48) and average excess weight loss (EWL) of 52.9% (25-97) did not differ from that of the remaining patients at the respective time interval. The band was removed in all cases. Conversion to RYGBP was performed at the same time in 11, and a few months later in 2 patients. Operative morbidity included 1 leak (reoperation) and 4 wound infections. All but 1 patient lost further weight after reoperation, or at least maintained their weight. At last follow-up, mean EWL in relation to the pre-banding weight was 65.1%, and 69.2% of the patients had an EWL >50%, which compares favorably with the results obtained after primary RYGBP. CONCLUSIONS: In our series with a median follow-up >4 years, band erosion was more common than usually reported. Band removal with immediate or delayed conversion to RYGBP is feasible with an acceptable morbidity, and prevents weight regain in most cases. These results support further use of this approach for band erosion.
Obes Surg. 2004 Mar;14(3):381-6