Iatrogenic Injury of the Intrathoracic Esophagus Sustained During a Gastric Banding Procedure

Abstract

The wide diffusion of laparoscopic adjustable gastric banding as a common surgical procedure for the treatment of morbidly obese patients can be attributed not only to the easy surgical technique, the ability to caliber the stoma, and the potential for reversibility, but also to the fact that this procedure is associated with a low rate of immediate postoperative complications compared to other more complex bariatric procedures. Herein reported is the case of a 63-year-old morbidly obese woman who sustained an iatrogenic injury of the intrathoracic esophagus during a laparoscopic adjustable gastric banding procedure. The putative mechanism of this previously unreported complication of laparoscopic adjustable gastric banding and the therapeutic options are discussed. The patient was initially treated with left pleural cavity drainage, antibiotics and the placement of an endoscopic silicone covered stent to cover the esophageal tear. Nine days later she underwent surgery through left thoracotomy due to the persistence of the esophageal leak. Esophageal perforation is a potentially life- threatening complication that may occur during a laparoscopic gastric banding procedure. The conservative treatment with an endoscopic stent should be reserved to patients with no signs of progressive systemic inflammation and include the drainage of the pleural cavity and the mediastinum, the endoscopic lavage and debridement. Standard surgical treatment with direct repair should not be retarded in case of persistence of the leak.

Thoracic complications in bariatric surgery patients

“…Surprisingly, 17.1% of patients had only abdominal surgical interventions while 15.38% had laparotomy plus thoracotomy and pulmonary resection. 12,23,49–55…”

Esophageal perforation during laparoscopic adjustable gastric band: conversion to open sleeve gastrectomy and endoscopic stent placement

“…There have been reported only a few cases, which were, usually, related with the intraoperative use of esophageal tube insertion or caused by erosion of the band into the esophagus (12,13).…”

Bariatric Surgery and the Gastric Tube—Caution for the Unwary Anaesthetist

“…'Never event' analysis indicates that problems from gastric tubes are the second most common anaesthetic-related event, after wrong surgery incidents 1 . There are published case reports of oesophageal injury from calibration tubes 2 . There are also reports of successful litigation against the anaesthetist following gastric tube-related injury 3 .…”