Laparoscopic repair of a migrated adjustable gastric band connecting tube with colonic erosion

Abstract

Laparoscopic adjustable gastric bands are a popular and effective surgical option to treat morbid obesity. The overall complication rate is 10–20% and the most common complication is of ‘slippage’. Although other complications such as gastric band migration and erosion have been reported, the phenomenon of a migrated gastric band connecting tube eroding into the colon (after port removal) is seldom reported in the literature. In this article we describe such a case of an incidentally found colonic erosion on colonoscopy and describe the subsequent laparoscopic repair, as well as a review of the literature.

Laparoscopic adjustable gastric band erosion with intragastric band migration: A rare but serious complication

“…Although typically seen in the late postoperative setting, intragastric band migration has been reported as early as 1 year postoperatively [10] . Although the majority of migrated bands are intragastric in location, several case reports have described free migration into the abdominal cavity as well as small bowel and colonic erosion [5] , [6] , [18] . Migrated gastric bands have also been reported to have passed distally beyond the initial site of erosion throughout the alimentary tract, including 1 case with the band migrating to the rectum resulting in a transient large bowel obstruction [5] , [18] , [19] .…”

“…Although the majority of migrated bands are intragastric in location, several case reports have described free migration into the abdominal cavity as well as small bowel and colonic erosion [5] , [6] , [18] . Migrated gastric bands have also been reported to have passed distally beyond the initial site of erosion throughout the alimentary tract, including 1 case with the band migrating to the rectum resulting in a transient large bowel obstruction [5] , [18] , [19] . Patients are frequently asymptomatic with studies reporting 7%-46% of asymptomatic patients with intragastric band migration incidentally found on routine screening with gastroscopy [14] , [20] .…”

“…First introduced in 1993, laparoscopic adjustable gastric banding (LAGB) consists of an inflatable gastric band placed below the gastroesophageal junction resulting in the creation of a gastric pouch, with the effective diameter of the band controlled by a subcutaneous port via a connecting tube [3] . Although originally a popular surgical technique at the time of its introduction, highly reported complication rates of 10%-26% have resulted in a marked decline of LAGB insertion, now accounting for only 6% of all bariatric surgeries [4] , [5] , [6] . Reported complications and incidence of laparoscopic gastric banding include band erosion (28%), port-tubing disconnection (20%), band slippage (4%-13%), incisional hernia (5%), port infection (2%), gastric band erosion with intragastric band migration (2%-4%), and gastric perforation (0.1%-0.8%) [7] , [8] , [9] .…”