Rodrigo Gonzalez, MD, Edwin Bran, MD, Fernando Montufar, MD
Las Americas Private Hospital
BACKGROUND: Band erosion is a known complication following gastric banding and physicians are increasingly being exposed to patients with this problem. Its presentation can sometimes be subtle, making it difficult to diagnose even for physicians with ample experienced in bariatric surgery. Therefore, it is important to determine the most common signs or symptoms that are present in order to diagnose this complication. Besides endoscopy, other less expensive and less invasive methods might be useful in its diagnosis. Treatment is not always possible through endoscopy and surgical approach is not always straightforward. Our aim is to review the presentation and the different alternatives for diagnosis and treatment of intragastric band erosion.
METHODS: We reviewed prospectively collected data of 916 patients undergoing gastric banding since the year 2000. Data from patients developing gastric band erosion at our institute, including clinical presentation, diagnostic methods and treatment alternatives were assessed. All patients with band erosion underwent band removal through endoscopy when the buckle of the band was inside the stomach. Otherwise patients underwent laparoscopic division and removal of the band. In cases with abundant intraabdominal adhesions hindering the safe access to the band, a gastrotomy in the anterior gastric wall and intragastric division and removal of the band was performed. Data were evaluated using Student’s t-test and are reported as mean+/-SD. A p<0.05 was considered statistically significant.
RESULTS: Twenty-four (2.6%) patients developed gastric band erosion at 49+/-23 months follow-up. Average age was 42+/-11 years and 14 (58%) were male. BMI decreased from 44+/-7 to 30+/-5 kg/m2 (p<0.05) at the time of the diagnosis. Clinical presentation included oozing from the port incision (69%), epigastric pain (60%), vomiting (56%), and decreased oral intake (12%). Fifteen patients (63%) presented only one symptom. For the diagnosis of band erosion, positive findings were found in the following tests: 24/24 (100%) patients who underwent endoscopy, 14/16 (88%) patients who underwent a CT scan, 7/19 (32%) who underwent an upper gastrointestinal series, and 4/16 (25%) who underwent an abdominal plain X-ray. The band was removed through endoscopy in 11 (46%) patients, laparoscopic division of the band in 10 (42%) patients, and laparoscopic gastrotomy with intragastric removal of the band in 3 (12%) patients. There were no conversions to open surgery, length of hospital stay was 2+/-0.5 days, oral intake was started at 1+/-0.5 postoperative days complications occurred in 2 (6%) patients including neumonia and wound infection.
CONCLUSIONS: The clinical presentation of gastric band erosion is usually nonspecific and most patients present with only one sign or symptom. Although endoscopy is the standard diagnostic method, we believe that other less invasive and less expensive diagnostic methods, especially the CT scan, can be used to diagnose this problem. In our experience, endoscopic removal of the band is technically demanding only possible in less than 50% patients with band erosion. Consequently, other options should be considered in these patients. When laparoscopic division and removal of the band is not possible, the intragastric removal of the band being is a viable and safe option.
Session: Podium Presentation
Program Number: S088
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