Abstract
Background
Gastric banding surgery can fail if the patient develops frequent vomiting, intolerance of common food types or reflux. These patients can be divided into those with a well-defined anatomical problem such as slippage and those without. Intermittent gastric prolapse (IGP) is a possible explanation for some patients who do not achieve adequate early satiety without excessive food intolerance but have normal imaging.
Methods
A series of eight patients was identified over a 2-year period with findings consistent with IGP. Cases were identified in the process of normal clinical practice and details reviewed retrospectively. Specific diagnostic methods included measures to increase pouch pressure above the band by either stress barium or endoscopy with pressure challenge.
Results
The median time until diagnosis of IGP was 48.0 months (16–124), and weight loss over that time was 26.4 kg, or 69.6 % excess weight loss (EWL) (5.8–101.8). This fell to 43.7 % EWL after IGP was diagnosed and managed. The mean fill volume when the patients experienced IGP was 6.8 ml (4.5–9.0). Most patients were diagnosed by radiological investigation. Four patients underwent revisional surgery with the remainder treated conservatively.
Conclusions
Intermittent gastric prolapse may explain excessive food and fluid intolerance in gastric band patients who have normal initial imaging. These patients typically experience gross food intolerance with a relatively small increment in fluid volume with relief when the increment is removed. The diagnosis is best made with either modified stress barium or endoscopy with pressure challenge. Management entails establishment of a safe fill volume, modification of weight loss expectations and earlier discussion of revisional surgery.
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References
O’Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94.
Mittermair RP, Obermuller S, Perathoner A, et al. Results and complications after Swedish adjustable gastric banding-10 years experience. Obes Surg. 2009;19(12):1636–41.
Alhamdani A, Wilson M, Jones T, et al. Laparoscopic adjustable gastric banding: a 10-year single-centre experience of 575 cases with weight loss following surgery. Obes Surg. 2012;22(7):1029–38.
Parikh MS, Fielding GA, Ren CJ. U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc. 2005;19(12):1631–5.
Angrisani L, Alkilani M, Basso N, et al. Laparoscopic Italian experience with the Lap-Band. Obes Surg. 2001;11(3):307–10.
Burton PR, Brown WA, Laurie C, et al. Pathophysiology of laparoscopic adjustable gastric bands: analysis and classification using high-resolution video manometry and a stress barium protocol. Obes Surg. 2010;20(1):19–29.
Burton PR, Brown WA, Laurie C, et al. Effects of gastric band adjustments on intraluminal pressure. Obes Surg. 2009;19(11):1508–14.
Brown WA, Burton PR, Anderson M, et al. Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management. Obes Surg. 2008;18(9):1104–8.
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The authors declare that they have no conflict of interest.
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Clough, A.D., Moore, P.M. Intermittent Gastric Prolapse After Adjustable Gastric Banding is a Potential Cause of Band Intolerance: Clinical and Diagnostic Findings from Eight Patients. OBES SURG 25, 360–365 (2015). https://doi.org/10.1007/s11695-014-1515-4
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DOI: https://doi.org/10.1007/s11695-014-1515-4