title: An approach to the assessment and management of the laparoscopic adjustable gastric band patient in the emergency department.
abstract: OBJECTIVE
  As the number of obese people in Australia continues to increase, laparoscopic adjustable gastric banding (LAGB) surgery will become increasingly common. It is important for practitioners involved in the care of such patients to be able to accurately diagnose, and initially manage, pathology relating to the LAGB.
  
  
  METHODS
  A retrospective review of 56 presentations in 41 patients with LAGB, who presented to the ED of a major tertiary hospital, was performed. Note was made of presenting symptoms, investigations undertaken, subsequent diagnosis, and initial and definitive management.
  
  
  CONCLUSIONS
  The commonest presenting symptoms included abdominal pain, nausea, vomiting and dysphagia. The ultimate diagnosis was food bolus obstruction (18 presentations; 32.1%), port infection (11 presentations; 19.6%), band prolapse (9 presentations; 16.1%), band erosion (2 presentations; 3.6%) and subacute bowel obstruction (1 presentation; 1.8%). Food bolus obstruction was best diagnosed clinically. Plain abdominal X-ray was useful to identify prolapse. Infection was best diagnosed with the combination of clinical picture and wound swab. CT scan was helpful when suspecting a deep source of infection. From these data, two algorithms were developed, which can be used as a clinical aide to help practitioners in diagnosing and treating such complications appropriately.
  
  
  CONCLUSIONS
  It is important that health-care professionals are aware of the common presentations of problems following LAGB and have a basic paradigm for initial care. The present study identifies the presenting picture of various complications that can arise postoperatively, and describes an approach to the assessment and management of the LAGB patient in the ED.
authors.affiliation: Upper Gastrointestinal Surgery Unit, The Alfred Hospital, Prahran, Victoria, Australia. larafreeman@hotmail.com
authors.forename: Larissa
authors.initials: L
authors.lastname: Freeman
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
authors.forename: Anna
authors.initials: A
authors.lastname: Korin
authors.forename: Charles H C
authors.initials: CH
authors.lastname: Pilgrim
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: Peter
authors.initials: P
authors.lastname: Nottle
mesh_terms: D000328:Adult; D001315:Australia; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology; D016001:Confidence Intervals; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000706:statistics & numerical data; D005773:Gastroscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage; D055815:Young Adult