title: Late gastric pouch necrosis after Lap-Band, treated by an individualized conservative approach.
abstract: Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.
authors.affiliation: Clinica Chirurgica II, University of Padua, Padua, Italy. mirto.foletto@unipd.it
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Francesco
authors.initials: F
authors.lastname: De Marchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernante
authors.forename: Luca
authors.initials: L
authors.lastname: Busetto
authors.forename: Fabio
authors.initials: F
authors.lastname: Pomerri
mesh_terms: D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D013270:Stomach / Q000473:pathology* / Q000601:surgery*