Thrombosis of the Lap-Band system.
BACKGROUND
The laparoscopic adjustable gastric band (LAGB) has proven itself a procedure with excellent long-term weight loss results and extremely low morbidity and mortality. The LAGB has become an indispensable addition to the armamentarium of most bariatric surgeons. Commonly reported complications associated with the lap band system include gastric prolapse, band erosion, hardware infection, and port/tubing leakage.


METHODS
We report a case of a patient suspected of having a Lap-Band leak. He presented with a clinical course of multiple adjustments without restriction and inability to aspirate the expected volume from the band. Following adjustment under fluoroscopy he became severely dysphagic. He underwent urgent operative exploration and was found to have an intact but overinflated band. Under close inspection, a clot in the proximal band was noted, acting as a ball valve allowing the addition of fluid but not aspiration.


CONCLUSIONS
This case highlights an unusual explanation for what is thought of as typical signs of band leakage. In addition it raises serious questions about the importance of preventing blood and particulate matter from entering the Lap-Band system both at the initial operation and at subsequent adjustments.
Sherwinter
Danny A
DA
Department of Minimally Invasive Surgery, Maimonides Medical Center, 948 48th Street, Brooklyn, New York 11219, USA. DNsherwinter@yahoo.com
Powers
Colin J
CJ
Geiss
Alan C
AC
Howard
Melanie
M
Warman
June
J
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D020878:Device Removal; D003937:Diagnosis, Differential; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D013396:Suction; D013927:Thrombosis / Q000175:diagnosis*