Ver el código de «Lap band complications»

==Background==
*Laparoscopic adjustable gastric banding 
*Band placed at gastroesophageal junction and inflated to limit food passage 
*Band constriction adjustable via reservoir 
*Subcutaneous reservoir (~5ml port site) allows adjustment without invasive intervention 
*Postoperative complications near 10% over lifetime of patient 
*Patients typically discharged same day or POD #1

==Clinical Features==
*[[abdominal pain|Abdominal]], [[chest pain|chest]] or [[neck pain|neck]]/[[sore throat|throat pain]] 
*[[Nausea/vomiting]], food intolerance 
*[[Sepsis]], abnormal vitals

==Differential Diagnosis==
===Early===
''At or near time of banding or adjustment of band''
*Acute gastroesophageal obstruction - postop edema at application site forces proximal movement of the band, get KUB 
*Intra-abdominal bleeding 
*Perforated viscus 
**Esophageal pouch dilation – pain, vomiting, nausea

===Late===
''Weeks to years after adjustment or application''
*Chronic Slippage
**herniation of stomach through band 
**can occur long after surgery 
**may progress to gastric necrosis and perforation 
*Gastric Erosion 
**Band can erode through the full thickness of the gastric wall&nbsp;
**can present as a port site infection, gastrocutaneous fistula or intra-abdominal sepsis 
*Port Complications 
**primary overlying skin infection may represent extension of intra-abdominal process
**need antibiotic coverage for intra-abdominal and skin flora 
*Tubing Dislodgement
*Port Ulceration

==Evaluation==
*Lab workup dictated by presentation 
*Obtain an upright [[KUB]] to assess band position & slippage 
**Phi (φ) angle- Angle between a vertical line oriented through the spine and a second line running on the long axis of the lap band
**Normal is 4-58 degrees
*Swallow Study under fluoroscopy to assess for gastro-esophageal obstruction 
*CT Abd/Pelvis to assess for perforation (contained or free), abscess, intra-abdominal fluid or bleeding 
*Endoscopy – visualize inner lumen of esophagus and stomach for partial or full erosion

==Management==
*Early surgical consultation key for all patients suspected of having complications 
*Intra-abdominal [[sepsis]] management (fluids, antibiotics)
*Remember to dose [[Antibiotic|antibiotics]] for morbid obesity if necessary 
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation 

==See Also==
*[[Bariatric surgery complications]]
*[[Medical device complications]]

==References==
<references/>

[[Category:GI]]
[[Category:Surgery]]