Jejunal Obstruction After Complete Transmural Gastric Band Migration

Florian Primavesi, MD, Tarkan Ja ̈ger, MD, Michael Baschata, MD,
Dietmar Ofner, MD, MAS, MSc, FACSDepartment of Surgery, Paracelsus Medical University, Salzburg, Austria (all authors).

ABSTRACT

Introduction: Surgery for morbid obesity is constantly gaining popularity around the world, and laparoscopic adjustable gastric banding is among the most accepted standard procedures. Lately, growing evidence for long-term complications has been reported with this particular technique. While band erosion is described in~1% of patients, complete transmural migration is scarce but may lead to acute intestinal obstruction.

Case Description: We present the case of a 55-year-old man with the rare but potentially life-threatening late complication of a complete band migration and consecutive intestinal obstruction 12 years after laparoscopic adjustable gastric banding. Intraoperative findings showed ischemic pressure ulcers and kinking of a small bowel loop due to adhesions and the migrated band device; thus, partial jejunal resection was necessary. The development of a pronounced wound infection required prolonged ambulatory wound care, but ultimately there was no permanent morbidity.

Discussion: Our report aims to raise awareness of possible long-term problems in bariatric surgery, especially after gastric banding. It demonstrates the importance of continuous supervision of obesity patients including regular assessments to avoid and detect complications even years after surgery.

Key Words: Band migration, Laparoscopic gastric banding, Long-term complications, Morbid obesity, Small-bowel obstruction.

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