Simultaneous Gastric and Colic Laparoscopic Adjustable Gastric Band Migration. Complication of Bariatric Surgery

Abstract

Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive treatment for morbid obesity, which has proved its safety, efficiency, and reversibility. Postoperative complications are rare and might be related with the reservoir, connecting tube, or with the band itself. The lack or unspecificity of clinical signs and symptoms makes the diagnosis of gastric band erosion difficult. The authors present the case of a 54-year-old female, submitted to laparoscopic adjustable gastric banding in April 2004 (BMI = 40 kg/m(2)). During the first year, she reduced her body mass index to 30 and remained stable thereafter. In August 2008, while investigating a moderate colicky abdominal pain, she was submitted to a colonoscopy that showed part of the band inside the transverse colon. Two exams were performed: the abdominal CT scan, which showed the connecting tube inside the transverse colon lumen and the lap band which was apparently well positioned around the stomach, and an upper digestive endoscopy that revealed band migration to the stomach lumen. The patient underwent laparoscopic band removal and closure of both stomach and colon walls, thus treating the fistula. LAGB erosion and migration is a late complication of this surgery that frequently needs surgical removal. LAGB migration to colon or stomach is described in literature isolated. Simultaneous erosion to stomach and colon lumen, with a gastrocolic fistula formation, has never been described before, making this case a unique one.

Band migration in a patient after vertical banded gastroplasty

“…However, VBG is not a risk-free procedure. The late complication rate, reported in world literature, is estimated to be 6-26% [4]. It includes: occlusion of stomach canal with morsel, stenosis or occlusion of created stomach canal, rupture of stomach division with possible creation of gastro-gastric fistula, gastroesophageal reflux, enlargement of esophagus diameter or created pouch, restriction intolerance, hyperemesis, dysphagia, gastrointestinal hemorrhage, and migration of the band to the gastric lumen, small intestine, colon or outside the gastrointestinal tract, e.g.…”

“…Its frequency is estimated to be 0.6-10% [4]. It most commonly occurs in the first 2 years following the performed surgery.…”

“…World literature reports recommend both endoscopic and surgical methods (laparoscopy, classic laparotomy) [12]. It is believed that an attempt of endoscopic removal can be carried out if the band migration is not accompanied by other complications [4]. Reoperation is technically more difficult to perform because of scarring, primarily in the area of the cardia [4].…”

“…Its efficacy in achieving and maintaining weight reduction has been proven as well as partial or complete withdrawal of numerous pathologies being its result. Simultaneously it improves quality of life and increases survival rate [4].…”

“…Migration of the gastric band into the gastric lumen is a rare complication which may occur after every bariatric surgery with the use of it. Its frequency is estimated to be 0.6-10% [4].…”