Treating Gastric Band Slippage: Symptoms, Diagnosis, and Recovery

Gastric Band Slippage Treatment

Some patients experience difficulty with their band without an identifiable technical problem. This can lead to frustration and relapse.

Correctly positioned bands are situated about 5 cm below the diaphragm and have a rectangular appearance on abdominal radiographs. A slipped LAGB can be diagnosed by anterior-posterior x-rays and upper gastrointestinal series [1, 2]. It can occur either antero-posteriorly or postero-laterally.

Symptoms

Laparoscopic adjustable gastric banding (LAGB) is a safe and effective bariatric procedure that has low morbidity and mortality rates. However, this popular treatment does have a few complications that patients need to be aware of. In particular, early gastric band slippage can be a serious problem for those undergoing this surgery.

A patient suffering from early gastric band slippage might experience pain, nausea or vomiting. Food cannot move through the stomach smoothly if the opening is too narrow, so patients can experience problems with hard and dry foods that are not well chewed or liquids that cannot pass easily.

Symptoms of a slipped band can be diagnosed using a diagnostic test called an upper gastrointestinal (GI) series. Often, a radiologist will ask the patient to drink some nasty-tasting barium, which will help them to take pictures of their stomach pouch. If a slip is suspected, the radiologist will be able to see it and can then perform an X-ray.

Diagnosis

The patient presented with the classic symptoms of band slippage including food intolerance, early satiety, regurgitation and chest pain. She had also lost weight. She had a history of laparoscopic gastric band removal and adjustable gastric bypass surgery.

Anterior band prolapse (type 1 prolapse) or posterior fundus herniation superiorly through the lap-band is a common complication and is related to disruption of fixation sutures or increased pressure from premature pouch fill, overeating or early solid food ingestion [3]. A type 2 prolapse is a more serious problem associated with incorrect surgical technique or herniation of distal stomach tissue into the proximal pouch.

A loss of the normal rectangular appearance of the proximal pouch on upper gastrointestinal series is called an “O sign” and is a reliable indicator of band slippage (Figure 1). This patient had a type 2 prolapse which required immediate surgical intervention to prevent gastric outlet obstruction. [4]

Treatment

Gastric band slippage treatment options depend on the severity of the complication. In mild cases, the band may be able to be repositioned. This requires drinking barium fluid which will flow down the esophagus and into the stomach pouch. The surgeon will then be able to see the precise position of the band on a radiology scan.

Alternatively, the band can be endoscopically removed. This procedure is more invasive and can lead to complications such as port site infection.

It is very important for patients with a gastric band to be seen regularly by the surgeon who placed it. This allows the patient to get the correct diagnosis and to be educated on how to avoid further complications. A good understanding of how the band works and what to expect can help the patient maintain their weight loss success. Symptoms of a slip should be discussed as early as possible. This will prevent long term problems such as reflux, vomiting or malnutrition.

Recovery

In patients whose symptoms persist or follow up contrast upper gastrointestinal series demonstrate a slipped band position, surgical intervention is required. This may involve band deflation and repositioning, removal or conversion to sleeve gastrectomy (SG) depending on the patient’s preference and the extent of gastric slip.

A large slip can cut off the blood supply to the stomach below and is a medical emergency. It is important that any patient who has an anterior slip (type 1 prolapse) or a posterior fundus herniation through the band is seen by their surgeon immediately.

It is also worth noting that there are a number of long term complications reported with the gastric band including pouch dilatation, band erosion and infection of the port which can lead to its removal. Other problems include a flipped or migrated port which can be fixed with a short procedure under general anesthesia. There are also rare reports of tubing mischief around the abdomen that can cause oesophageal dysfunction.

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