Bariatric emergencies for non-bariatric surgeons: complications of laparoscopic gastric banding.
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) has gained popularity for treatment of morbid obesity worldwide. With the widespread use of LAGB, an increasing number of medical specialists are dealing with the potentially life-threatening complications of this procedure.


METHODS
More than 6,000 LABGs were performed by our surgeons during the past 11 years, during which various complications of LAGB were observed, including band slippage, erosion, gastric pouch dilatation, port infection, and disconnection. Complicated cases requiring emergency surgical intervention were collected. We present and discuss the diagnostic and therapeutic possibilities of these complications.


RESULTS
Fourteen cases were identified: six with acute band slippage, two with small bowel obstruction, and one each with band slippage and fetal intrauterine growth restriction during the 36th week of pregnancy, perforated gastric ulcer, upper gastrointestinal bleeding, connecting tube penetration into a stomach ulcer, connecting tube penetration into the colon, and port disconnection. All patients had gastrointestinal symptoms at admission. Band reposition was performed in four cases; eight patients required band removal for band contamination. The band was open and still in place in one case. Open and laparoscopic gastric resections for necrotic stomach were performed in two cases. Suture of perforated gastric ulcer was combined with cesarean section. Connection of disconnected port and suture of colonic and gastric penetrations and perforation of fundus were completed laparoscopically. Small bowel resection and enterotomy required an additional minimal laparotomic incision. No mortality was observed in our series. Four patients elected to have the LAGB reinserted at a later time.


CONCLUSIONS
The increasing number of bariatric procedures has resulted in emergency physicians' knowledge of serious complications of LAGB that require urgent surgical intervention. Treatment algorithms require early diagnosis and a surgical approach to solving these conditions.
Kirshtein
Boris
B
Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva, 84101, Israel. borkirsh@bgu.ac.il
Lantsberg
Leonid
L
Mizrahi
Solly
S
Avinoach
Eliezer
E
D000328:Adult; D000465:Algorithms; D004630:Emergencies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery