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

Abstract

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.

Endoscopic Approach for Major Complications of Bariatric Surgery

“…The use of a silastic band or ring is very common in vertical gastroplasty or LAGB, and even in RYGB, and it may cause several complications, such as band slippage, gastric pouch outlet stenosis, and band erosion during its long-term placement around the upper stomach just below the EGJ. Among these complications, band erosion, the late process of intragastric band migration, may lead to loss of satiety, weight regain, and even infection at the port site, although most patients are asymptomatic [ 86 ]. The incidence of band erosion is variable and has been reported as 0.3%–1.9% among large-scale studies that included more than 100 patients, and a recent systemic review of 15,775 patients who underwent LAGB reported an overall incidence of 1.5% [ 87 ].…”

Snakeskin Appearance of Gastric Mucosa Compressed by Adjustable Gastric Bands: A Novel Diagnostic Marker of Band Migration

“…The sensitivity of SSA for prediction of band migration is 60% (3/5) ( Table 2). about the optimal timing of migrated AGB removal [11,[15][16][17][18][19], many case reports have been issued describing serious complications arising from long standing band migration, including liver abscess [20], small bowel injury [21], delayed bleeding [22,23], and peritonitis [13,24]. One Group B patient in the present study also presented with acute peritonitis at 6 months after a diagnosis of SSA.…”

Laparoscopic adjustable gastric band erosion and migration into the proximal jejunum

“…Gastric erosion and intragastric migration have been described previously as unusual complications that are commonly asymptomatic with no pathognomonic presentation [4]. The patient presentation is usually dependent on the extent of erosion and position of migration.…”