Laparoscopic adjustable gastric banding - JSLS

Gastric Banding Causing Adnexal Entrapment During Pregnancy

SLS — Sat, 15 Nov 2014 19:27:10 +0000

Zvi Vaknin, MD, Hasan Kais, MD, Noga Fuchs, MD, Sharon Berger, MD, Moty Pansky, MD, Noam Smorgick, MD, Msc

Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Beer Yaakov, Israel (Drs. Vaknin, Fuchs, Berger, Pansky; Smorgick). Department of General Surgery B, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Beer Yaakov, Israel (Dr. Kais).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding (LAGB) is commonly used for the management of morbid obesity in women of reproductive age. This surgery was found to be safe and well tolerated during pregnancy, with a lower incidence of gestational diabetes and maternal hypertension than was found in control subjects. The most common complications of LABG include gastric perforation, band slippage, and port disconnection. We present an unusual complication of LABG during pregnancy.

Case Description: The patient is a 34-year-old pregnant woman who underwent LABG 3 years prior to her pregnancy and presented at 14 weeks’ gestation with acute left lower quadrant abdominal pain. Laparoscopy was performed for suspected adnexal torsion (based on clinical presentation and sonographic findings), revealing an entrapment of the left adnexum by the connecting tube of the LAGB device. The left adnexum was released with no residual complications.

Discussion: This complication, although rare, should be considered during early pregnancy.Key Words: Laparoscopic adjustable gastric banding, Pregnancy, adnexal torsion.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00216.pdf”]

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Emergent Sleeve Gastrectomy for Gastric Necrosis Resulting From Lap Band Slippage

SLS — Sat, 15 Nov 2014 17:04:02 +0000

Minal Joshi, MD, Krystyna Kabata, PA-C, Srikanth Earhiraju, MD, Michael Baek, MD, Piotr J. Gorecki, MD

Department of Surgery, New York Methodist Hospital, Brooklyn, NY, USA (all authors).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding (LAGB) has a potential for long-term complications. We report a case of LAGB slippage with extensive gastric necrosis managed with emergent sleeve gastrectomy.

Case Report: A 45-year-old man presented to the emergency department after returning from a distant trip and reported a 3-day history of progressively severe abdominal pain, nausea, vomiting, and fever. He had undergone placement of the LAGB 2 years before this presentation, which resulted in subsequent weight loss of 143 lb and resolution of his comorbidities. On admission, the patient was hypotensive, tachycardic, and oliguric, with evident peritonitis. A computed tomography scan revealed extensive intraperitoneal free air and intra-abdominal fluid. After intravenous fluid resuscitation, he underwent emergent exploratory laparoscopy. A slipped band with gastric prolapse and extensive gastric necrosis were found, with multiple perforations involving most of the greater curvature of the stomach. The LAGB was explanted and a laparoscopic sleeve gastrectomy was performed. A liquid diet was introduced on postoperative day 4. Immediate recovery was prolonged because of acute-onset chronic renal failure and requirement for optimization of nutrition. The patient was discharged home on postoperative day 13 and had a subsequent uneventful recovery.

Conclusion: Gastric prolapse complicated by gastric necrosis is a rare life-threatening complication of LAGB. Once acute LAGB slippage is suspected, urgent attention and treatment are needed to minimize the chance of gastric ischemia. Laparoscopic explanation of LAGB and emergent sleeve gastrectomy may be considered in similar clinical settings to optimize the outcome and minimize the morbidity of near total or total gastrectomy.

Key Words: Laparoscopic adjustable gastric banding, Morbid obesity, Gastric necrosis, Sleeve gastrectomy, Gastric prolapse, Lap band slip.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00180.pdf”]

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Abdominal Catastrophe During Pregnancy Due to a Gastric Band

SLS — Sat, 15 Nov 2014 04:40:54 +0000

Gurdeep S. Matharoo, MD, Samir R. Shah, MD, Steven J. Binenbaum, MD, Frank J. Borao, MD

Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA (all authors).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding is popular bariatric procedure for patients with morbid obesity. The procedure is appealing to patients and surgeons because of its customizable approach to weight loss. The rate of complications after laparoscopic adjustable gastric banding has been reported to be up to 12.2%. Without a high degree of suspicion, the complications can go unrecognized until they have progressed to a catastrophic state.

Case Description: We present a 32-year-old pregnant woman, with a history of laparoscopic adjustable gastric banding, who presented with complaints of persistent nausea and vomiting causing significant weight loss. She was treated with intravenous hydration and antiemetic medication. After 3 days of in-hospital treatment, she was discharged home after resolution of symptoms. She then returned to the hospital with severe abdominal pain. The fetal heart tones were lost, and she delivered a stillborn fetus. Radiologic testing suggested abdominal hollow organ perforation, and the patient was taken to the operating room. Diagnostic laparoscopy discovered a prolapsed gastric band causing obstruction and an anterior gastric perforation proximal to the band. The perforation was repaired primarily, and an omental patch was used as a buttress.

Conclusion: Although nausea and vomiting are common symptoms during pregnancy, their cause must be fully investigated in bariatric patients. The complications in bariatric patients can be catastrophic if not recognized and treated appropriately. As weight loss surgery increases in popularity and age limits are decreased, more women of childbearing age will present after bariatric procedures, and all complications must be ruled out.

Key Words: Laparoscopic adjustable gastric banding, LAGB, Pregnancy, Bariatric surgery, Hyperemesis gravidarum, Abdominal catastrophe.[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00174.pdf”]

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