- Present with obstructive symptoms
- 15% 1st 3 yrs, > 50% at 10 yrs
- Usually anterior slippage
- Investigations
- AXR to look at PHI angle
- Posterior slippage
- O-sign - gastric band being visible end on
- Anterior slippage – band rotates clockwise
- Recognised by loss of normal phi angle (10 - 60 degrees)
- Contrast swallow
- Creates acute angle between oesophagus and stomach
- Can lead to ischaemia of Fundus
- Management
- Deflate band completely, may resolve symptoms
- If works, then adequate acute rx, and send back to surgeon for further review
- May need removal of band
- Or repositioning (by bariatric surgeon)
Gastric band erosion
- 1-7%
- Aetiology
- Gastric wall ischaemia from tight band placement
- Trauma/injury during band placement
- Presents with
- Pain, nausea, vomiting +/- haematemesis
- Failure of weight loss/Loss of restriction
- Red port sign (infected port)
- Usually seals itself so unusual to see free peritonitis
- Investigations
- Diagnosed endoscopically
- CT scan to look for leak/collection (rare)
- Management
- Removal of band - Generally lap
- Cut down over the capsule surrounding the band
- There may be gastro-gastric stitches that need to be removed
- Cut down onto buckle of band with diathermy
- Divide band and then remove it
- May need distal gastrotomy to access if phlegmon
- Leave a drain
- ALWAYS – Keep all pieces of the band on a mayo table and reassemble to be sure entire band is removed
- Dysphagia
- Can be
- Slippage
- Over inflation
- Fibrotic foreign body reaction/oedema from surgery
- First step is to remove all of fluid from band
- Pillow behind lower back
- Lift head like sit-up
- Brace with fingers and insert Huber needle
- Huber needle is non-coring
- If can’t find, then use 25g fine bore
- NB: Can get pseudo-achalasia with the bands and resultant dysmotility