Prosthesis related sepsis following laparoscopic adjustable gastric banding.
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) is well-recognized as a superior method to achieving durable weight loss in the medium term when compared with non-surgical methods of weight loss. In this paper, we described the clinical presentation and outcomes of patients presenting with band or band-adjustment reservoir sepsis from our series from a single institution.


METHODS
We conducted a retrospective review of prospectively collected clinical, anthropometric and biochemical data from patients who underwent LAGB placement over a five-year period at a metropolitan teaching hospital. Those patients requiring surgical intervention for prosthesis-related sepsis were included in the review.


RESULTS
Of the 445 patients in this series, 10 (2.2%) developed prosthesis sepsis and required operative intervention. Three (0.7%) presented with reservoir sepsis requiring removal of the reservoir. One had band erosion identified and the entire prosthesis removed. In seven (1.5%) of the patients, infections occurred at the gastric band. Two patients presented with purulent peritonitis and underwent immediate band removal. The remainder presented with band abscesses and either had their band removed (three patients) or left in position and the sepsis treated with drainage and antibiotics (two patients).


CONCLUSIONS
In our current series, a small proportion of LAGB patients developed prosthesis-related infection that typically required port or band removal and usually occurred early in the post-operative course. We have modified our prophylactic antibiotic regime and surgical technique as a result of this review. In selected cases of band infection, bands were salvaged with subsequent acceptable weight loss, suggesting that LAGB salvage in the presence of sepsis may be achievable in some patients.
Facek
Michael
M
Department of Upper Gastrointenstinal Surgery, Royal North Shore Hospital, NSW, Australia.
Receveur
Imke
I
Darbar
Archie
A
Richardson
Andrea
A
Leibman
Steven
S
Smith
Garett
G
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015992:Body Mass Index; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents