Late gastric pouch necrosis after Lap-Band, treated by an individualized conservative approach.

Author: Foletto M, De Marchi F, Bernante P, Busetto L, Pomerri F

Author affiliation: Clinica Chirurgica II, University of Padua, Padua, Italy. mirto.foletto@unipd.it

Publication date & source: 2005.11, Obes Surg., 15(10):1487-90.

Publication type: Case Reports

Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.