Laparoscopic Gastric Band: Early and Late Complications




© Springer International Publishing Switzerland 2017
Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_13


13. Laparoscopic Gastric Band: Early and Late Complications



Nidhi Khanna 


(1)
Department of General Surgery, Rowan University, Stratford, NJ, USA

 



 

Nidhi Khanna



Laparoscopic adjustable gastric banding (LAGB), although a good option for weight loss, does have its associated complications.

Early complications:



  • Food intolerance


  • Obstruction


  • Perforation


  • Venous/pulmonary thromboembolism


  • Bleeding


  • Infection (early or late)

Late complications:



  • Band erosion


  • Band slippage (early or late)


  • Pouch enlargement


  • Esophageal dilatation


  • Port or tubing defects


  • Failed weight loss

Food intolerance exhibited by nausea and vomiting is the most common early complication associated with LAGB but can also be an indication of obstruction. Obstruction occurs at an incidence of 0.5–11 % [1]. Simply adjusting the fluid in the band may help alleviate these symptoms. While adjustment may be done at the bedside, many surgeons prefer to do it under flouroscopy for ease of both the patient and the surgeon. Band slippage can also lead to obstruction and will be discussed later in the chapter. Perforation is rare and the incidence is less than 1 % [1].

Non-band-related complications are bleeding, wound infection, and venous thromboembolism (VTE). The incidence of VTE varies and is reported at less than 1 % to as high as 3.5 %. Pulmonary embolism (PE) is rare but can have an incidence as high as 1 %. Bariatric patients have several risk factors for VTE including but not limited to hypercoagulable state, venous stasis, and obesity hypoventilation syndrome. Patients undergoing obesity surgery must have aggressive prophylaxis and be monitored closely for signs and symptoms of VTE [2].

Another complication is failed weight loss. Because the LAGB is purely restrictive, this technique requires full compliance on the patient’s part. If dietary restrictions are not followed and poor eating habits continue, this will lead to poor results. Furthermore, patients may be converted to a gastric sleeve or Roux-en-Y gastric bypass with good results [1].

Band erosion can occur in up to 6.8 % of cases [1]. Pressure from the band buckle or a tightly placed band can gradually erode into the stomach. Symptoms vary from epigastric pain to gastrointestinal bleeding to abscess. Endoscopy can be performed to make the diagnosis. Treatment is band removal, repair of stomach, or conversion to another procedure at another time [1] [2].

Band slippage is a rare incident occurring at a rate of 0.4–8 % [1] and can be divided into five classifications. Type I is an anterior slip where the band slips downwards on the stomach, and type II is a posterior slip where the posterior portion of the stomach slips upwards through the band. Type III is pouch enlargement (discussed in the following paragraph). Type IV is an immediate postoperative slip and type V is necrosis of the stomach associated with types I and II. This can be diagnosed with an upper gastrointestinal (UGI) series X-ray. Reoperation with band removal or re-positioning is warranted for this complication with the exception of type III [3]. Furthermore, patients can be converted to a gastric sleeve or bypass after several weeks if the gastric band is removed [1].

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Jun 25, 2017 | Posted by in NURSING | Comments Off on Laparoscopic Gastric Band: Early and Late Complications
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