Laparoscopic Management of Internal Hernia Due to Adjustable Gastric Band Tubing

Osama Hamed, MBBS, Lashondria Simpson, MD, Emanuel Lomenzo, MD PhD, Mark Kligman, MD. Department of Surgery University of Maryland School of Medicine Baltimore, MD


 Introduction: Laparoscopic adjustable gastric banding (LAGB) is the most commonly performed bariatric procedure worldwide. Device related morbidity is typically related to the subcutaneous port or the band proper. Complications related to band tubing are unusual. Small bowel obstruction (SBO) after LAGB is a potentially devastating complication, due to the possibility of creating a closed loop obstruction between the band and the more distal obstruction. SBO due to internal hernia through looped band tubing is very rare with few cases reported in the literature.
Methods: A 69 year old male presented with nausea, vomiting and colicky abdominal pain. He had a history of LAGB placement 3 years prior to presentation. CT scan showed high grade proximal small bowel obstruction with transition point related to a loop formed by the band tubing around the base of the mesentery.
Results: During laparoscopic exploration the omentum was shifted into the right abdomen where it was fixed by adhesions from pervious surgery. Redundant band tubing was looped around the base of the mesentery of the small bowel creating an internal hernia. After reduction of the internal hernia; the redundant band tubing was functionally shortened by positioning the excess tube in the right suprahepatic space where it was secured by plicating the falciform ligament to omental adhesions in the right upper quadrant, the omentum was then mobilized and interposed between the tubing and bowel.
Conclusion: SBO after LAGB require special attention, immediate band deflation and NG decompression. Because of the potential for closed loop bowel obstruction, early operative intervention is advocated in Tubing-related SBO. Recurrence of this complication can be achieved by minimizing the tubing length and by avoiding direct contact between the tubing and intestine.

Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V073

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