Exsanguinating Hemorrhage following Gastric Erosion after Laparoscopic Adjustable Gastric Banding

Abstract

Laparoscopic adjustable gastric banding (LAGB) has become a common bariatric operation, because of its safety, laparoscopic friendliness, acceptable weight loss and absence of long-term adverse nutritional sequelae. Gastric erosion is one of the troublesome complications of gastric banding. The etiology and presentation of erosion remain obscure. We present a patient who complained of persistent pain 6 months after gastric banding. Endoscopy revealed the band to be normally situated, which was also confirmed on upper GI imaging. Despite this, the patient subsequently presented with massive GI hemorrhage and circulatory collapse due to erosion, which necessitated emergency laparotomy with retrieval of the band from within the gastric lumen. This case highlights the possible urgent presentation of erosion after gastric banding, which was hitherto considered to be a more insidious complication. A high index of clinical suspicion remains the mainstay of diagnosis.

Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years

“…The more significant complications include band slippage, pouch dilation, and intragastric band migration or band erosion (BE), the last of which forms the focus of our report [4][5][6]. The incidence of BE is reported to range from 0.5% to 11% depending on the intensity of the search to detect it and the duration of the follow-up period [7,8].…”

The Gastric Banding

“…The anamnesis findings concerning weight gain without any signs of band loosening are characteristic [14,[22][23][24][25][26][27][28]. ▬ Slippage (anterior and posterior), i.e., displacement of the anterior or posterior gastric wall above the band with consequent increase of the "upper" stomach volume, allowing ingestion of larger amounts of food, ⊡ te Riele et al [17] Naef et al [14] Lee et al [12] Boschi et al [21] Boschi et al [18] Lagandré et al [19] Vomiting due to stoma edema 0. often with obstruction at the band site associated with too large "volume" of the gastric wall inside the band lumen.…”

Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

“…Gastric band erosion is a relatively common, long-term complication (> 6 months) of LAGB surgery associated with weight regain, chronic port-cutaneous fistulas, protracted port site infections, insidious peritonitis, subphrenic abcesses and GI bleeding, but the exact etiology of band erosion is unclear [8,9]. Chronic ischemia due to pressure on gastric wall by the device, chronic inflammation of tissue adjacent to the band or weakening of gastric wall due to intraoperative gastric wall trauma may all contribute the gastric band migration leading to erosion [9,10].…”

“…Chronic ischemia due to pressure on gastric wall by the device, chronic inflammation of tissue adjacent to the band or weakening of gastric wall due to intraoperative gastric wall trauma may all contribute the gastric band migration leading to erosion [9,10]. Erosion itself, moreover, does not always involve the stomach or the band itself.…”