Management of Band Erosion with Omental Plugging: Case Series from a 5-Year Laparoscopic Gastric Banding Experience

Cherian, P. Thomas; Goussous, Ghaleb; Sigurðsson, Ásgeir

doi:10.1007/s11695-009-9925-4

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…It was always confirmed by a regular passage of Gastrografin in the stomach, without extraluminal effusion, and the patients could resume oral feeding immediately. Gastric repair by suturing or omental patch placement frequently is reported instead after laparoscopic or laparotomic band removal [5,19,21]. In these cases, breaching of the capsule is necessary to remove the band but leaves an open gastric fistula.…”

Section: Discussionmentioning

confidence: 99%

Treatment of band erosion: feasibility and safety of endoscopic band removal

et al. 2011

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Despite a few complications, endoscopic removal seems to be the procedure of choice for the treatment of band erosion. It allows quick resumption of oral feeding and rapid discharge of patients and appears to be safer and more effective than laparoscopic removal. Conversion to surgery is unlikely but possible. Therefore, the authors always recommend that the procedure be performed in the operating room.

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Section: Discussionmentioning

confidence: 99%

Treatment of band erosion: feasibility and safety of endoscopic band removal

et al. 2011

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“…We carefully dissected and identified the lap-band tubing up to the band buckle, then debuckled the locking system using a laparoscopic grasper and removed the band system. Four steps were performed for safe closure of the remaining gastric perforation after band removal; 1) primary repair (PR): using 2-0 Ethibond (Ethicon Inc.), an interrupted suture was used to close the defect, 2) omental plugging (OP): segmentation of the vascularized omentum was fashioned and gently inserted through the tunnel (i.e., that leads into the stomach) that is usually left behind by the extracted band and fixed in place using multiple sutures through a relatively healthy gastric wall [14], 3) drainage catheter insertion (DR): one subhepatic (at the level of suture line) and one left subphrenic Jackson-Pratt (JP) drain were inserted through a left subcostal incision, and 4) nasogastric tube insertion (NT): a nasogastric tube was inserted for decompression of the air and drainage of gastric juice, and the tube was maintained for postoperative 48 hours. Patients with documented BE requiring surgical re-intervention were identified from a database and case notes were reviewed.…”

Section: Methodsmentioning

confidence: 99%

Early experience with diagnosis and management of eroded gastric bands

2012

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PurposeBand erosion is a well-known complication of laparoscopic adjustable gastric band placement. We gained experience with laparoscopic removal of an eroded gastric band.MethodsWe retrospectively reviewed the operative log of our obesity surgery unit to identify all operations performed for band erosion from March 2009 to May 2011.ResultsDuring the study period, a total of six of 96 patients (6.3%), five females and one male, were diagnosed with band erosion and underwent surgical removal of the band system. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 8.5 months (range, 7 to 22 months), with most band erosion occurring within the first year (5/6, 83%). The median body mass index at band removal was 28.4 kg/m2. Upper abdominal pain was the most common symptom (5/6, 83%), and other signs and symptoms were port site infection (3/6, 50%) and loss of restriction and weight regain (1/6, 17%). All eroded bands were removed using laparoscopy. Further complications after laparoscopic removal of the band system were observed in three cases. One patient showed multiple intra-abdominal abscesses requiring insertion of a pigtail catheter for drainage. The other two patients experienced sepsis with localized peritonitis, eventually requiring laparoscopic washout and drainage.ConclusionGastric band erosion requires the removal of the gastric band. Laparoscopic removal is technically achievable in the majority of patients with eroded gastric band. The method can be challenging, has potential postoperative complications (fistula, abscess), and should be attempted only by experienced surgeons.

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“…A laser technique was described by Weiss et al [40], who preferred to cut the sutures with endoscopic scissors and then burn through the silicone bridge of the closure site of the band with a laser. Other techniques have been described but their relevance was limited by the singlecenter provenance and limited number of patients [41].…”

Section: Discussionmentioning

confidence: 99%

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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Management of Band Erosion with Omental Plugging: Case Series from a 5-Year Laparoscopic Gastric Banding Experience

Cited by 11 publications

References 24 publications

Treatment of band erosion: feasibility and safety of endoscopic band removal

Treatment of band erosion: feasibility and safety of endoscopic band removal

Early experience with diagnosis and management of eroded gastric bands

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

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