A Serious but Rare Complication of Laparoscopic Adjustable Gastric Banding: Bowel Obstruction Due to Caecal Volvulus

Abstract

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for the treatment of morbid obesity. LAGB complications have declined since its development in the early 1990s. However, LAGB complications are still occurring and can sometimes be serious and life threatening. These complications are related either to the band or to the access port, such as band slippage or tubing disconnection, retrospectively. We report a rare case of bowel obstruction due to caecal volvulus caused by connecting tube used in LAP-BAND system in a bariatric operation, which obstructed a caecal loop, in a female who had undergone LAGB 2 years previously. Diagnosis of bowel obstruction was established with plain abdominal radiograph appearances. Follow-up abdominal computed tomography findings confirmed the diagnosis of caecal obstruction and revealed the underlying cause for this obstruction. Surgery was performed, and intraoperative examination demonstrated that connecting tube of the LAP-BAND system was a main causative factor. We can hypothesize that bowel obstruction secondary to LAGB operation may become frequently diagnosed as more LAGB operations performed worldwide. The emergence of many problems, such as this, can be minimized with enhancement in the development of better surgical materials, proper operative technique, and close postoperative management and follow-up.

An Unusual Complication 4 years After Laparoscopic Adjustable Banding: Jejunal Obstruction Due to the Connecting Tube

“…CT scan seems to be the diagnostic cornerstone in evaluating the cause of the bowel obstruction; findings in our case were very suggestive that the connecting tube must be the cause of the intestinal obstruction. Other authors also stress the importance of a CT scan in comparable cases [10,11]. Stoker et al also emphasizes the value of CT scan for evaluating bowel obstruction as a cause of acute abdominal pain [12].…”

Bowel obstruction and cecal volvulus as a complication of laparoscopic adjustable gastric banding: A case report

“…These complications arose from 1.5 to 9 years after placement of the LAGB. [8][9][10][11][12][13][14] Additionally, patients frequently report significant discomfort in the postoperative period and complain of reflux like symptoms and dysphagia. Fifty percent of patients questioned by Gustavsson with a standardized protocol two years post-LAGB admitted to heartburn and acid regurgitation.…”

“…Tan, et al [13] Small Bowel Obstruction; Colonic Erosion of Connection Tubing 5 Years Primary Repair of Colonic Perforation; Omental Patch; Removal of Gastric Band Shipkov, Uchikov, and Uchikova [14] Small Bowel Obstruction Due to Connection Tube 9 Years Bowel Resection with End Ileostomy; Later Ileo-to-Ileo Anastomosis…”

“…[7] Other studies have reported novel late complications such as recurrent small bowel obstruction caused by the connecting tube of a LAGB [8][9][10][11] and cecal volvulus caused by the band tube. [12][13][14] We report a case of cecal volvulus caused by adhesion of the cecum to the gastric band tubing. While cecal volvulus has been reported in previous case studies, we are not aware of any reported cases caused by adhesion of the cecum directly to the gastric band tube.…”

Simultaneous cecal volvulus and gastric erosion secondary to laparoscopic adjustable gastric band

“…Small bowel obstruction and/ or strangulation occurs when tubing wraps around mesentery, cutting off blood supplying the associated segment of bowel [3,4]. Similarly, cecal volvulus is extremely rare but reported in a few cases [5][6][7]. These complications likely result from the tendency to leave extra tube length to simplify potential future operations [5].…”