Slippage of Gastric Banding for Mobid Obesity: case report and review of literature

Background: laparoscopic adjustable gastric banding (LABG) remains the commonest and less invasive bariatric operation. It has many advantages in the treatment of obesity and is associated with low morbidity and mortality rates.When it happens a Gastric Band Slippage (GBS), part of the gastric fundus herniates through the band. Removal of GB is necessary to prevent necrosis of the herniated stomach.Case report: We present a case of a 40-year-old female patient who was admitted for a huge gastric pouch dilatation after 3 years of underwent LAGB.Conclusion: The LAGB is one of the most common procedures used for the treatment of morbid obesity. The complications are generally not mortal but it is necessary that complications have been recognized by general surgeon and physicians should be aware of the symptoms. Diagnosis of GBS can be made with signs or symptoms and patient’s medical history, with the use of oral contrast X-ray studies or CT Scan and surgical intervention is necessary.

1502 UK National Survey of Huber Needle Availability for Deflation of Gastric Band Balloon in The Acute Setting

Introduction The laparoscopic gastric band was popularised in the 1990’s. The procedure involves placement of an adjustable band around the proximal stomach, aiming to induce satiety and offering a surgical solution to morbid obesity. Complications such as band slippage and erosion, together with succession by sleeve gastrectomy and gastric bypass which offer more significant weight loss has meant the procedure has gone out of favour. However, their legacy continues with a stream of patients presenting annually with complications, many of whom have travelled abroad for the procedure. The aim of this study was to examine Huber needle availability in acute surgical units nationally. Method All acute general surgical admission units across the UK were identified from the National Emergency Laparotomy Audit database. The senior nurse managing each unit was contacted by telephone and asked three questions; whether their hospital has an elective bariatric service on site, whether they review acute bariatric emergencies and whether the unit stocks Huber needles. Results 151 acute general surgical units were identified across the UK, of which 60% responded. 30/90(33%) have an elective bariatric service on site and 65/90(72%) reviewed acute bariatric patients. 8/90(8.9%) stock Huber needles for the acute deflation of gastric bands. Conclusions Patients presenting acutely with gastric band complications typically need urgent deflation of the gastric band. The Huber needle is a non-coring needle used for gastric band adjustment, preventing damage to the port. The Huber needle is a low-cost item and should be stocked by all acute general surgical units.

Bleeding from band ligation-induced ulcers following the treatment of oesophageal varices: a retrospective case–control study.

Background Band ligation (BL) plays a vital role in the treatment of oesophageal varices; however, the procedure carries a considerable risk of band slippage, variceal site ulcer formation and post-treatment bleeding. Our study aimed to explore the incidence of post-BL ulcer bleeding and to identify possible associated factors.Methods We retrospectively reviewed the records of patients with oesophageal varices who underwent endoscopic haemostasis by BL at our institution between 2015 and 2020. We statistically compared the patients with post-BL ulcer bleeding and those without (controls). The outcome variable was the development of BL-induced ulcer bleeding. The patients’ demographics, clinical and laboratory parameters, BL procedure outcomes and experts’ opinions were used as the independent variables and possible associated factors. Results Of the 4579 eligible patients 388 (8.5%) presented with post-BL ulcer bleeding. Proton pump inhibitor (PPI) use was associated with a lower risk of post-BL ulcer bleeding (odds ratio, 0.77; 95% confidence interval [CI]: 0.603–0.983). The presence of high-risk stigmata indicated a 1.276 times higher risk of bleeding (CI: 1.024–1.592), and a greater number of varices was associated with an increased risk of post-BL ulcer bleeding (P = 0.007). The use of fewer bands per variceal site was associated with fewer bleeding incidents (P = 0.008), while lower haemoglobin levels were associated with a higher probability of bleeding (P = 0.007).Conclusions The overall incidence of post-BL ulcer bleeding was 8.5%. The presence of high-risk stigmata and a higher number of varices and bands per variceal site were associated with an increased risk of bleeding. Adequate haemoglobin levels and the use of adjuvant PPIs and having were protective factors.

Prevention and Management of Complications of Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is an effective option for the treatment of severe obesity. Its longstanding history has allowed us to understand its advantages, limitation, complications, and management. LAGB continues to have an excellent perioperative safety record but can have delayed complications due to the nature of being a device. By understanding these complications, the clinician can easily identify, treat and prevent their occurrence. The most common complications of gastric prolapse with band slippage, device breakdown and weight loss failure can all be addressed conservatively or surgically. This chapter addresses in a systematic format the short- and long-term complications of gastric banding.t

Gastropericardial Fistula as a Late Complication of Laparoscopic Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is a bariatric procedure that is being performed with increasing frequency as an alternative management option for morbid obesity. Several common complications have been reported including gastric band slippage and associated pouch dilatation, intragastric erosion of the band, gastric wall perforation, and abscess formation. We present a case of gastropericardial fistula occurring nine years after an LAGB. There have been no previous documented cases of the complication after this procedure.