The procedure is safe, cheaper and reversible. The stomach is divided into upper and lower compartments with the help of a band made of silicone. The silicone is inflated with sterile water and the water can be increased or decreased via the tube that extends from the silicone band to an area below the skin of the abdomen.
The upper stomach accommodates small amount of food and this leads to early satiety, while the lower stomach communicates with the upper one and serves to convey the partially digested food from the smaller stomach to the intestine.
However despite the relative safety of the procedure over the other bariatric procedures, complications do occur. These complications can be those that are common to other bariatric procedures such as anesthetic complications, or those that are specific to the gastric banding procedure.
The complications and the risk of gastric banding are however below the risk of death associated with obesity itself. One out of every ten premature deaths among Canadian adults between the ages of 20–64 years has been linked to obesity.1
Pouch enlargement, band slip, band erosion, port-site infections and port breakage represent the complications most commonly associated with laparoscopic adjustable gastric banding.2
Enlargement of the pouch (upper gastric compartment) is one of the complications of gastric banding. An incident of 12% was reported in a study.3 It usually follows overeating or over-inflation of the band with subsequent increase in intra-gastric pressure. There may be associated enlargement of the distal portion of the esophagus. Patients with pouch enlargement after gastric banding often experience absence/delay in sensation of fullness following meal and chest pain that is burning in character.
The condition can be managed either non-operatively or operatively. The non-operative treatment involves deflation of the band and low calorie diet. This is then followed by a contrast study after 6wweks to assess the position of the band and the pouch size. This can then be followed by re-inflation of the band if the position and pouch size are satisfactory.3
Surgical exploration with removal and/or replacement of the band is indicated if the above management fails to restore the pouch size back to its original size.
Movement of the band below the level of placement or prolapse of the stomach above the level of the band is another complication associated with gastric banding. Incidence varies between 1-22% depending on the approach used.2 Band slippage is an acute complication that often necessitate an operative intervention either with the removal or repositioning of the band. Presentation includes difficulty in swallowing, vomiting, and regurgitation.
In rare conditions the silicone band may erode into the wall of the stomach and eventually into the lumen of the stomach. The reported incidence is less than 1%.2Erosion may be due to injury to the wall of the stomach during band placement or tight band placement.2The condition may be present without any symptom or there may be symptoms such as epigastric pain, loss of sensation of fullness following meal, passage of dark shining stool, etc. Treatment is complete removal of the band by laparoscopic or open surgery.2
Intra-abdominal abscess may complicate gastric banding due to breech of asepsis during band placement. The band itself serves as a foreign body. Drainage and removal of the band is the treatment of choice.
Infection of the port site may occur following laparoscopic gastric banding. Port site is the area where the water within the silicone band is adjusted. Pain, swelling, redness with or without discharge are the clinical features of port site infection. Strict asepsis during surgery, prophylactic antibiotics will help reduce the incidence of this complication.
Laparoscopic adjustable gastric banding is a restrictive bariatric surgical procedure that is used in the treatment of morbid obesity. It is commonly done due to its safety, low cost, and reversibility. However it is not without some specific complications. Many of these complications can however be minimized by appropriate surgical technique and prophylactic measures. Though every complication leads to additional cost of healthcare and increase in the length of hospital stay, early diagnosis and treatment will go a long way in minimizing the possible mortality associated with these complications.
- Costs of Gastric Bypass Surgery
- Life and Recovery of Gastric Bypass Surgery
- Pre-Operative Gastric Bypass Diet
- Post-Operative Gastric Bypass Diet
- Lau D, Douketis J, Morrison K, Hramiak I, Sharma A, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. Canadian Medical Association Journal. 2007;176(8):S1-S13. doi:10.1503/cmaj.061409.
- Eid I, Birch DW, Sharma AM, Sherman V, Karmali S. Complications associated with adjustable gastric banding for morbid obesity: a surgeon’s guide. Canadian Journal of Surgery. 2011;54(1):61-66. doi:10.1503/cjs.015709.
- Moser F, Gorodner M, Galvani C, Baptista M, Chretien C, Horgan S. Pouch enlargement and band slippage: two different entities. Surgical Endoscopy. 2006;20(7):1021-1029. doi:10.1007/s00464-005-0269-4.