Intragastric Band Erosion After Laparoscopic Adjustable Gastric Banding for Morbid Obesity: Imaging Characteristics of an Underreported Complication

Hainaux, Bernard; Agneessens, Emmanuel; Rubesova, Erika; Muls, Vinciane; Gaudissart, Quentin; Moschopoulos, Constantin; Cadière, Guy-Bernard

doi:10.2214/ajr.184.1.01840109

Cited by 52 publications

(31 citation statements)

References 11 publications

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“…In most cases the diagnosis of migration was made when the band appeared incorrectly positioned during fluoroscopy which was performed for band adjustment [27]. In our experience, the majority of patients were asymptomatic (Table 2) and the erosion was diagnosed during follow-up.…”

Section: Discussionmentioning

confidence: 89%

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Lorenzo

Furbetta

et al. 2012

Surg Endosc

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Background Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB. Methods A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand Ò (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered. Results From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21-62 years); mean BMI = 46.7 ± 7.7 kg/m 2 (range 37.3-68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36-130); %EW 91.1 ± 32.4 % (range 21-112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of followup, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6-12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not. Conclusions Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.

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Section: Discussionmentioning

confidence: 89%

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Lorenzo

Furbetta

et al. 2012

Surg Endosc

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“…One of the most serious complications associated with gastric banding is erosion of the band into the gastric lumen [2], and its incidence ranges between 0.6% and 11% [2][3][4][11][12][13][14][15][16][17]. After an initial tear of the serosal layer of the stomach, the band erodes the complete thickness of the gastric wall and enters the lumen.…”

Section: Discussionmentioning

confidence: 99%

“…Inadvertent surgical gastric injury or gastro-gastric sutures overlying the locking mechanism of the band are thought to contribute to gastric erosion of the band [18]. Other possible contributing factors of transmural band penetration include: the abuse of nonsteroidal anti-inflammatory drugs, inflammatory response to foreign material such as silicone, chronic infection, noncompliant behavior from the patient, and frequent vomiting [6,12,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…In our series, perforation occurred after six months of band placement in one patient, and after nine and 10 years in the other two patients. The clinical presentation of patients with LASGB related complications are usually nonspecific and may include abdominal pain, increased food consumption, cessation of weight loss, regain of lost weight [13], or may be as serious as sepsis due to peritonitis secondary to gastric perforation [6,8,12,20,21]. Other presenting symptoms include: loss of satiety, increase in weight, access port site infection, and lack of response to band adjustment [3].…”

Section: Discussionmentioning

confidence: 99%

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Management of Complications Related to Laparoscopic Adjustable Silicone Gastric Band

Arrangoiz¹

2017

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Laparoscopic adjustable silicone gastric band (LASGB) is frequently used to treat morbidly obese patients worldwide. Complications related to this procedure have increased as the follow-up interval of these patients has increased. Treatment of these complications often includes removal of the silicone band. Herein we report our experience with silicone gastric band removal, discuss the different treatment alternatives, and present a management algorithm. A retrospective review of complications related to LASGB was made from June of 2003 to April of 2010 (eight patients). Techniques of band extraction are discussed and a management algorithm is presented. The mean Body Mass Index at the time of LASGB placement was 39.45 (Range 34.2 -42.8). The median patient's age at the time of LASGB was of 32.6 years (range: 13 to 50 years). The average durability of the silicone band after laparoscopic placement was 67.8 months (range: 6 to 120 months). In three patients (37.5%) the LASGB had perforated the gastric wall and was therefore extracted using a transgastric approach (laparoscopic in two patients and by laparotomy in one patient). In five patients the silicone band had not perforated the stomach and was therefore removed laparoscopically without entering the stomach. The weight was recovered in 37.5% of the patients during follow-up. Management of patients with complications related to LASGB placement must be individualized and should address both the band related complication as well as the obesity problem. Laparoscopic trans-gastric band extraction is ideal when the LASGB has eroded into the stomach and endoscopic extraction is not feasible.

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“…CT scans are the most important diagnostic cornerstone in determining the position of the band and its connecting tube in the stomach wall. Barium contrast radiography provides additional information on other complications of gastric banding such as band slippage or pouch dilatation [17].…”

Section: Migrated Band Fixed Endoscopically 245mentioning

confidence: 99%

Endoscopic Management of Penetrated Adjustable Gastric Band with Its Connecting Tube: Report of a Case

et al. 2011

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Intragastric Band Erosion After Laparoscopic Adjustable Gastric Banding for Morbid Obesity: Imaging Characteristics of an Underreported Complication

Cited by 52 publications

References 11 publications

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Management of Complications Related to Laparoscopic Adjustable Silicone Gastric Band

Endoscopic Management of Penetrated Adjustable Gastric Band with Its Connecting Tube: Report of a Case

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