Pouch enlargement

Pouch enlargement (type-III prolapse) is diagnosed when dilation of the proximal gastric pouch is present with or without change in the angle of the band and in the absence of signs of obstruction.

The lower esophagus may or may not be dilated. Pouch enlargement is a pressure-related phenomenon that may be surgically induced by band over inflation or overeating with resulting high pressure in the pouch.

Symptoms of pouch enlargement include lack of satiety, heartburn, regurgitation and occasional chest pain. The diagnosis is made with an upper gastrointestinal series

Nonoperative treatment includes complete band deflation, low-calorie diet, re-enforcement of portion size and follow-up contrast study in 4–6 weeks. If the band position and the pouch size return to normal, then the band can be incrementally re inflated. A study by Moser and colleagues demonstrated that this conservative approach to pouch enlargement was successful in up to 77% of patients. Conservative treatment is considered unsuccessful when the pouch fails to recover its original size after 8–10 weeks. In this circumstance, surgical treatment with either band removal or replacement is indicated.

Band slip

Band slip may be defined as cephalad prolapse of the body of the stomach or caudal movement of the band. Other published literature report an incidence of slip of 1%–22%.

Since the cross-sectional area of the stomach is larger at the body than at the level of the angle of His (normal band position), complete obstruction of the stomach can occur when the band slips. Band slip can be posterior or anterior, depending on whether the anterior or posterior region of the stomach herniates through the band.

Anterior slip (type-I prolapse)

Anterior slip results from upward migration of the anterior wall of the stomach through the band. This can be due to insufficient anterior fixation and disruption of the fixation sutures. The second cause may be related to increased pressure in the pouch due to early solid food, vomiting, overeating or early (< 4 wk) band fill.

Posterior slip (type-II prolapse)

Posterior slip is defined as a herniation of the posterior wall of the stomach through the band. This is usually related to the surgical technique but is less frequent now with adoption of the pars flaccida approach instead of the perigastric approach

In both types of slip, the patient usually presents with dysphagia, vomiting, regurgitation and food intolerance. The diagnosis is made by upper gastrointestinal series. Complications related to band slip include gastric perforation, necrosis of the slipped stomach (type-V prolapse), upper gastrointestinal bleeding and aspiration pneumonia.

Type-IV prolapse

A type-IV prolapse is defined as an immediate postoperative prolapse and is usually due to placing the band too low on the stomach.

Band slip types (I, II, IV and V) are acute and always require surgical intervention. Laparoscopic removal or repositioning of the band is the preferred method of treatment. Pouch enlargement is a chronic complication that should be managed nonoperatively in the first instance, and surgical readjustment is reserved only for those patients in whom conservative treatment fails.

Band erosion

Band erosion is an uncommon complication of LAGB. In this scenario, the band gradually erodes through the stomach wall and into the gastric lumen. The incidence is less than 1%, with a reported prevalence varying from 0% to 11%.

The etiology of band erosion may be the result of gastric-wall injury during band placement or tight anterior fixation, especially around the band buckle.

A high index of suspicion is required for diagnosis of band erosion as most patients are asymptomatic. When symptomatic, complaints related to erosion include loss of restriction, nonspecific epigastric pain, gastrointestinal bleeding, intra-abdominal abscesses or port-site infection. The diagnosis is often made at the time of gastroscopy.

The recommended treatment is complete removal of the eroded gastric band laparoscopically or via laparotomy.

Port-site infection

Port-site infections can be classified as early and late. Early infections will manifest with the cardinal signs of erythema, swelling and pain. These infections typically occur within the immediate postoperative period and may be reduced by the use of perioperative antibiotics. Early infection with cellulitis alone may be treated with oral antibiotics. If the response is inadequate, then intravenous antibiotic use is warranted. When the infection does not respond to intravenous antibiotics and is limited to the port, the port should be removed and the tubing knotted and left inside the abdomen. Once the local infection is resolved, a new port may be placed and tubing connected with laparoscopic guidance. Late port site infections are often caused by delayed band erosion with ascending infection. This usually manifests several months after surgery and can be associated with loss of restriction. These infections typically do not respond well to antibiotic treatment. If left undetected, band infection can evolve into potentially life-threatening intra-abdominal sepsis. Gastroscopy will confirm the diagnosis of band erosion. This complex clinical scenario is treated most expeditiously by removal of the band.

Port breakage

Breakage or damage of the port typically refers to leakage through a damaged port septum or tubing leading into the port. The use of a standard coring needle is strongly discouraged, and only Huber (noncoring) needles should be used to access the port. If port access is difficult or if the tubing connected to the port is at risk of perforation, then band adjustment under fluoroscopy is advised. Port breakage usually manifests as a slow leak with the loss of the injected Fluid volume on aspiration and the absence of restriction. It can be difficult to identify the leak site but local exploration of the port site can confirm the diagnosis.

I'm posting this because these are things we as Lap Band Patients should be aware of, I'm a firm believer of "Being forewarned is being Forearmed

Jackie who are you and what made you the WORLD AUTHORITY on lapbands ond WLS? You have 8 posts , 2 topics yet you come across as though you know everything? Why haven't we had the benefit of all your knowledge previously or is it just that you keep changing your name because you annoy people so much?

Are you some kind of missionary that you feel the need to inform everyone about the risks of the EVIL band?

The point was the NOT EVERYONE knows about the RARE complications, and since I now know that a lot are due to patient's non compliance,NOT band failure, or those rare complications, I'll just tell everyone that wants to Know about having a LB to GO GET ONE if you need to have surgery because of a slip HEY, no problem, it's not like it's major suregery. And all your health problems from being obese will go away with that LB.

Sorry I posted INFORMATION it won't happen again .

Wow...calm.

I think the problem is the way you portrayed the information. It came across like another gloom and doom post against the Lap Band.

If you really want to help people, they need to be aware of all the ways they can sabotage themselves with the band. Their greatest risk of severe complications isn't from their band it's from their own non-compliance and bad behavior.

This OP is clearly just an angry picketer sent to this forum from Westboro's new Against Lap Bands chapter I wouldn't mind them too much.

I'm not a band basher, I've had my band since 04/2009, I've been doing fine with my band but the information posted to most people isn't factual. the studies only give us the information they want to disclose.

I apologize, I probably should have prefaced the post to: Newbie's having problems, so they can ask questions of their surgeons IF they are experiencing any of the aforementioned problems.Yes I'm new but honestly I guess my problem is that I prefer Facts to anecdotal information.

This is so annoying.. It's like everyday regular people wanna push scientific data down others throats... Funny thing is unless your a doctor that specializes in WLS.. U have no business tying to "educate" people on the lapband.

There's so many factors missing.. And all this is really gonna do is make people paranoid.

Reminds me of the study that linked Tylenol to heart failure or cancer to sugar free gum

It's a shame that this topic has become so inflamed as there has been some information posted that is of interest and benefit to people researching the lap band or possibly having complications.

IMO the most important thing to remember is that this is a forum for discussion. We are not WLS surgeons, we do not know enough about each other's personal health situations, we possibly don't even know how to properly read and interpret findings from studies.

The best we can do is share our experiences, be supportive and encourage each other to get proper medical advice when needed.

One of the issues with WLS in general is there are unscrupulous surgeons out there willing to take our money, rush people thru the paperwork and not fully disclose the risks. This seems to be especially true of Lapband due to the $$$ to be made with aftercare.

I think Jackie's intent was to inform those who might be taken advantage of by these types of surgery mills...

One of the issues with WLS in general is there are unscrupulous surgeons out there willing to take our money, rush people thru the paperwork and not fully disclose the risks. This seems to be especially true of Lapband due to the $$$ to be made with aftercare.

I think Jackie's intent was to inform those who might be taken advantage of by these types of surgery mills...

I agree with you totally. I see people come on here all the time that are seriously and totally clueless because their surgeons didn't educate them at all. Unfortunately, this is especially true of people going to Mexico for bands.

I don't doubt Jackie's intentions, and I'm sorry for any misunderstandings, but unfortunately a lot of us are on the defensive because of band bashers and took her post the wrong way.

I think that when our bands are working great, we're losing, complication free and enjoying doing things we haven't done in years, we are willing defend our tool and our choice vigorously against "band bashing".

The problem is that often the signs that things are getting off track are confusing, feel like other minor issues, until we hit a wall, so to speak. The problems I'm hearing about with bands and motility often feel like something else (esophageal spasms feel like angina) or something commonplace, such as constipation. The other big red flag is when you hear of someone stuck on Water or other liquid. They think their band has randomly tightened, though they haven't had a fill in months or years. In this case, they might be experiencing what I am...achalasia, failure of the LES to open in response to swallowing. This is above the band, food, liquids back up in the esophagus causing dilation and damage.

When I post of complications I've had, it is purely to educate, inform and help someone else who might not realize they're experiencing the early warning signs of band complications. Knowing these signs, reacting quickly could mean they reduce the pressure in their band, lessen the damage and save their GI tract from permanent and painful damage. The intent is not to bash, just to inform.