Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication JMBS

CASE REPORT

JMBS Journal of Metabolic and Bariatric Surgery J Metab Bariatr Surg 2015;4(2):46-48

Received: September 30, 2015, Revised: October 12, 2015, Accepted: October 20, 2015 Corresponding author: Sang-Moon Han, 566 Nonhyun-ro, Gangnam-gu, Seoul 06135, Korea

Department of Surgery, Gangnam CHA Medical Center, School of Medicine, CHA University Tel: 82-2-3468-3369, Fax: 82-2-3468-3507, E-mail: [email protected]

Copyright © 2015, The Korean Society for Metabolic and Bariatric Surgery

Spontaneous Unbuckling of the Adjustable Gastric Band;

A Rare Complication

Department of Surgery, Gangnam CHA Medical Center, School of Medicine, CHA University, Seoul, Korea

Ji-Sun Hong, Sang-Moon Han

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.

Key Words: Laparoscopic adjustable gastric banding, Over-filling, Complication, Unbuckled band

INTRODUCTION

Laparoscopic adjustable gastric banding (LAGB) is a restrictive surgical procedure which has low morbidity and mortality rate in the immediate postoperative period along with acceptable weight loss [1-3]. However, we occasionally meet the common long-term complications such as gastric pouch dilatation, gastric band slippage and band erosion.

In this case study, we report a patient who does not feel satiety in the face of inflation of band, treated via removal of unbuckled band which is rare complication.

CASE REPORT

A 24-year-old female had undergone LAGB (MIDBAND

) procedure with severe obesity at our hospital in February 2013. At the time of LAGB, her weight was 86 kg with a

body mass index (BMI) of 35.3 kg/m

. She had co-morbid conditions of hyperlipidemia, fatty liver disease, snoring, and knee and back pain. In the postoperative period, her lowest recorded weight was 62 kg with a BMI of 25.5 kg/

m

at 12 months. She had regular follow-up and greatly satisfied with LAGB procedure during postoperative 1 year.

She had uneventful course until postoperative 15 months.

She had weight regain since 15 months, began experien-

cing repeated over-filling. However, she did not feel food

passage disturbance despite of over-inflation of band, and

her weight increased to 73 kg with a BMI of 30 kg/m

in

October 2014. Therefore, she underwent the upper gast-

rointestinal series and a gastroscopy to find abnormal

complications. Abnormal findings were not detected by

these tests. Diagnostic laparoscopy was recommended and

performed in October 2014. An incision was made at the

previous trocar site in the supra-umbilicus, and the tubing

Ji-Sun Hong Sang-Moon Han:

Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication

Journal of Metabolic and Bariatric Surgery 47

Fig. 1. Diagnostic laparoscopy showing unbuckled MIDBAND

.

was disconnected. A laparoscopic procedure was perfor- med showing a low dense peri-gastric fibrosis with adh- esion to a left liver lobe. The surrounding adhesions were dissected with a hook cautery. The buckle of the band was identified and remained unbuckled state (Fig. 1), and then unbuckled band was released and removed. The other gastric band (LAP-BAND AP

) was placed in previous area.

There was no morbidity in the postoperative period. Six months later (April 2015), her weight was 59 kg with a BMI of 24.2 kg/m

.

DISCUSSION

The number of LAGB cases has sharply decreased due to long-term complications of the band itself (port and tubing system problems, gastric pouch dilatation, gastric band slippage and band erosion) and high re-operation rate [4-7]. However, the LAGB was a leading procedure in Korea because of the low morbidity and mortality rate to those who are considered morbidly obese [8].

Band adjustment is very important to achieve restriction of food after LAGB. Without timely adjustment of band using saline, weight loss can be less than optimal, which may be associated with weight loss failure or poor com- pliance. Despite of proper adjustment and regular follow- up after LAGB, no restriction of food was often experi- enced because of gastric band erosion, band leak or tubing system leak. Gastric band erosion is confirmed by gas- troscopy, and band system itself problem may be confirmed by fluoroscopy-assisted gastrografin test. If these tests are normal, diagnostic laparoscopy may be

needed to evaluate the band system failure. Unbuckled band is a rare complication after LAGB. Cunneen et al. [9]

reported 1 (0.4%) case of unbuckled band in prospective Realize adjustable gastric band-C (RB-C) study. RB-C requires higher filling volumes to achieve the proper stoma area. Also, MIDBAND

is a high volume filling band.

Therefore, over-filling may be often occurred in MID- BANDTM. To escape the complications after LAGB, the less aggressive band fills resulted in fewer complications. The lack of satiety was encountered after LAGB Despite of over-filling. Especially, in this situation, the prompt evaluation for band itself system is needed to exclude a vague possibility of gastric band erosion or band leaking and to treat unbuckled band surgically.

With the increasing number of LAGB procedures being performed in Korea, the surgeon has to cope with potential complications including band system itself failure, that is to say unbuckled band. In this case, the bariatric surgeon should perform additional diagnostic laparoscopy pro- cedure.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

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