Ver el código de «Lap band complications»

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==Background==

*Laparoscopic adjustable gastric banding <ref>Fried M, Miller K, Kormanova K. Literature review of comparative studies of complications with Swedish band and Lap-Band. Obes Surg. 2004 Feb;14(2):256-60. PMID 15018757</ref>
*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==

*[[Special:MyLanguage/abdominal pain|Abdominal]], [[Special:MyLanguage/chest pain|chest]] or [[Special:MyLanguage/neck pain|neck]]/[[Special:MyLanguage/sore throat|throat pain]] 
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]], food intolerance 
*[[Special:MyLanguage/Sepsis|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 [[Special:MyLanguage/KUB|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 [[Special:MyLanguage/sepsis|sepsis]] management (fluids, antibiotics)
*Remember to dose [[Special:MyLanguage/Antibiotic|antibiotics]] for morbid obesity if necessary 
*Consider deflating band via port site if impending gastric necrosis due to edema/recent band inflation 


==Disposition==
*Admit for:
**Band slippage with obstruction or inability to tolerate liquids
**Band erosion (requires surgical removal)
**Peritonitis or signs of perforation
**Severe dehydration from prolonged vomiting
*Discharge with surgical follow-up for:
**Mild port-site complications
**Resolved obstructive symptoms after band adjustment
**Mild reflux symptoms

==See Also==

*[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]]
*[[Special:MyLanguage/Medical device complications|Medical device complications]]


==References==

<references/>

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