Surgical Endoscopy

, Volume 27, Issue 4, pp 1151–1157 | Cite as

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

  • Nicola Di Lorenzo
  • Michele Lorenzo
  • Francesco Furbetta
  • Franco Favretti
  • Cristiano Giardiello
  • Sergio Boschi
  • Genco Alfredo
  • Giancarlo Micheletto
  • Vincenzo Borrelli
  • Augusto Veneziani
  • Marcello Lucchese
  • Marcello Boni
  • Simona Civitelli
  • Ida Camperchioli
  • Vincenzo Pilone
  • Maurizio De Luca
  • Paolo De Meis
  • Massimiliano Cipriano
  • Michele Paganelli
  • Vincenzo Mancuso
  • Angelo Gardinazzi
  • Angelo Schettino
  • Roberta Maselli
  • Pietro Forestieri
Article
First Online:
Received:
Accepted:

Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB.

Methods

A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand® (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered.

Results

From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21–62 years); mean BMI = 46.7 ± 7.7 kg/m2 (range 37.3–68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36–130); %EW 91.1 ± 32.4 % (range 21–112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of follow-up, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6–12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not.

Conclusions

Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.

Keywords

Laparoscopic adjustable gastric band Bariatric surgery Obesity 
This is a preview of subscription content, log in to check access.

Notes

Disclosures

All authors declare to have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Carelli AM, Youn HA, Kurian MS, Ren CJ, Fielding GD (2010) Safety of the laparoscopic adjustable gastric banding: 7 years data from US center of excellence. Surg Endosc 24:1819–1823PubMedCrossRefGoogle Scholar
  2. 2.
    Egberts K, Brown WA, O’Brien PE (2011) Systematic review of erosion after laparoscopic adjustable gastric banding. Obes Surg 21:1272–1279PubMedCrossRefGoogle Scholar
  3. 3.
    Angrisani L, Furbetta F, Doldi SB, Italian Group for Lap-Band (GILB) (2003) The Lap Band adjustable gastric banding system: the Italian experience with 1863 patients operated on 6 years. Surg Endosc 17:409–412PubMedCrossRefGoogle Scholar
  4. 4.
    Dargent J (2004) Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure - a 9-year series. Obes Surg 14:986–990PubMedCrossRefGoogle Scholar
  5. 5.
    Nocca D, Frering V, Gallix B, de Seguin des Hons C, Noe P, Pierredon Foulonge MB, Millat B, Fabre JM (2005) Migration of adjustable gastric banding from a cohort study of 4,236 patients. Surg Endosc 19:947–950PubMedCrossRefGoogle Scholar
  6. 6.
    Cherian PT, Goussous G, Ashori F, Sigurdsson A (2010) Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years. Surg Endosc 24:2031–2038PubMedCrossRefGoogle Scholar
  7. 7.
    Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyc M, Fobi N (2001) Band erosion: incidence, etiology, management and outcome after banded vertical gastric bypass. Obes Surg 11:699–707PubMedCrossRefGoogle Scholar
  8. 8.
    Deitel M (1990) Erosion of Marlex band and Silastic ring into the stomach after gastroplasty. Am J Gastroenterol 85:665–666Google Scholar
  9. 9.
    Osborne DR, Hobbs KE (1981) Dacron graft erosion of the duodenum: a complication of interposition mesocaval shunt operations. Br J Surg 68:483–484PubMedCrossRefGoogle Scholar
  10. 10.
    Dutta S (2007) Prosthetic esophageal erosion after mesh hiatoplasty in a child removed by transabdominal endogastric surgery. J Pediatric Surg 42:252–256CrossRefGoogle Scholar
  11. 11.
    Meir E, Van Baden M (1999) Adjustable silicone gastric banding and band erosion: Personal experience and hypotheses. Obes Surg 9:191–193PubMedCrossRefGoogle Scholar
  12. 12.
    Ceelen W, Walder J, Cardon A, Van Renterghem K, Hesse U, El Malt M, Pattyn P (2003) Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg 237:10–16PubMedCrossRefGoogle Scholar
  13. 13.
    Neto MP, Ramos AC, Campos JM, Murakami AH, Falcão M, Moura EH, Evangelista LF, Escalona A, Zundel N (2010) Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases. Surg Obes Relat Dis 6:423–427PubMedCrossRefGoogle Scholar
  14. 14.
    Di Lorenzo N, Furbetta F, Favretti F et al (2010) Laparoscopic adjustable gastric banding via pars flaccida vs perigastric positioning: technique, complications and results on 2,549 patients. Surg Endosc 24:1519–1523PubMedCrossRefGoogle Scholar
  15. 15.
    Westling A, Bjurling K, Ohrvall M et al (1998) Silicone-adjustable gastric banding: disappointing results. Obes Surg 8:467–474PubMedCrossRefGoogle Scholar
  16. 16.
    Vertruyen M, Paul G (2003) 11-cm Lap-Band System placement after history of intragastric migration. Obes Surg 13:435–438PubMedCrossRefGoogle Scholar
  17. 17.
    Niville E, Dams A, Vlasselaers J (2001) Lap-Band erosion: incidence and treatment. Obes Surg 11:744–747PubMedCrossRefGoogle Scholar
  18. 18.
    Kurian M, Sultan S, Garg K, Youn H, Fielding F, Ren-Fielding C (2010) Evaluating gastric erosion in band management: an algorithm for stratification of risk. Surg Obes Rel Dis 6:386–389CrossRefGoogle Scholar
  19. 19.
    Christou N, Efthimiou E (2009) Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada. Can J Surg 52:E249–E258PubMedGoogle Scholar
  20. 20.
    Abu Abeid S, Szold A (2001) Laparoscopic management of LapBand erosion. Obes Surg 17:87–89CrossRefGoogle Scholar
  21. 21.
    Fried M (2008) The current science of gastric banding: an overview of pressure-volume theory in band adjustments. Surg Obes Relat Dis 4(3 Suppl):S14–S21PubMedCrossRefGoogle Scholar
  22. 22.
    Rao AR, Ramalingam G (2006) Exsanguinating hemorrhage following gastric erosion after laparoscopic adjustable gastric banding. Obes Surg 16:1675–1678PubMedCrossRefGoogle Scholar
  23. 23.
    Campos J, Famos A, Galvao MN, Siqueira L, Evangelista LF, Ferraz A, Ferraz E (2007) Hypovolemic shock due to intragastric migration of an adjustable gastric band. Obes Surg 17:362–364CrossRefGoogle Scholar
  24. 24.
    Iqbal M, Majunath S, Seenath M, Khan A (2008) Massive upper gastrointestinal hemorrhage: an unusual presentation after laparoscopic adjustable gastric banding due to erosion into the celiac axis. Obes Surg 18:759–760PubMedCrossRefGoogle Scholar
  25. 25.
    Png KS, Rao J, Lim KH, Chia KH (2008) Lap-band causing left gastric artery erosion presenting with torrential hemorrhage. Obes Surg 18:1050–1052PubMedCrossRefGoogle Scholar
  26. 26.
    Egbeare DM, Myers AF, Lawrance RJ (2007) Small bowel obstruction secondary to intragastric erosion and migration of a gastric band. J Gastrointest Surg 17:983–984Google Scholar
  27. 27.
    Hainaux B, Agneessens E, Rubesova E et al (2005) Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication. AJR Am J Roentgenol 184:109–112PubMedCrossRefGoogle Scholar
  28. 28.
    Ayloo S, Bueno R (2009) Band erosion: laparoscopic removal of lap-band. Surg Endosc 23:657–658PubMedCrossRefGoogle Scholar
  29. 29.
    Angrisani L, Lorenzo M, Santoro T, Nicodemi O, Persico G, Tesauro B (1999) Videolaparoscopic treatment of gastric banding complications. Obes Surg 9:58–62PubMedCrossRefGoogle Scholar
  30. 30.
    Kohn GP, Hansen CA, Gilhome RW, McHenry RC, Spilias DC, Hensman C (2012) Laparoscopic management of gastric band erosions: a 10-year series of 49 cases. Surg Endosc 26:541–545PubMedCrossRefGoogle Scholar
  31. 31.
    Patel S, Eckstein J, Acholonu E, Abu-Jaish W, Szomstein S, Rosenthal RJ (2010) Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis 6:391–398PubMedCrossRefGoogle Scholar
  32. 32.
    Suter M, Giusti V, Héraief E et al (2004) Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass. Obes Surg 14:381–386PubMedCrossRefGoogle Scholar
  33. 33.
    Abu-Abeid S, Bar-Zohar D, Sagie B, Klausner J (2005) Treatment of intragastric band migration following laparoscopic banding: safety and feasibility of simultaneous laparoscopic band removal and replacement. Obes Surg 15:849–852PubMedCrossRefGoogle Scholar
  34. 34.
    Chisholm J, Kitan N, Toouli J, Kow L (2011) Gastric band erosion in 63 cases: endoscopic removal and rebanding evaluated. Obes Surg 21:1676–1681PubMedCrossRefGoogle Scholar
  35. 35.
    Niville E, Dams A, Van der Speeten K, Verhelst H (2005) Results of lap rebanding procedures after Lap-Band removal for band erosion - a mid-term evaluation. Obes Surg 15:630–633PubMedCrossRefGoogle Scholar
  36. 36.
    Iacopini F, Di Lorenzo N, Altorio F, Schurr MO, Scozzarro A (2010) Over-the-scope clip closure of two chronic fistulas after gastric band penetration. World J Gastroenterol 16:1665–1669PubMedCrossRefGoogle Scholar
  37. 37.
    Galvao NMP, Ramos AC, Campos JM, Murakami AH, Falcao M et al (2010) Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases. Surg Obes Relat Dis 6:413–428Google Scholar
  38. 38.
    Regushi L, Groebli Y, Meyer JL, Walder J, Margalith D, Schneider R (2003) Gastroscopic removal of an adjustable gastric band after partial intragastric migration. Obes Surg 13:281–284CrossRefGoogle Scholar
  39. 39.
    O’Brien P (2010) Comment on: Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases. Surg Obes Relat Dis 6:427–428PubMedCrossRefGoogle Scholar
  40. 40.
    Weiss H, Nehoda H, Labeck B, Peer R, Aigner F (2000) Gastroscopic band removal after intragastric migration of adjustable gastric band: a new minimal invasive technique. Obes Surg 10:167–170PubMedCrossRefGoogle Scholar
  41. 41.
    Cherian PT, Goussus G, Sigurdsson A (2009) Management of band erosion with omental plugging: case series from a 5-year laparoscopic gastric banding experience. Obes Surg 19:1409–1431PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nicola Di Lorenzo
    • 1
  • Michele Lorenzo
    • 1
    • 2
  • Francesco Furbetta
    • 1
  • Franco Favretti
    • 1
  • Cristiano Giardiello
    • 1
  • Sergio Boschi
    • 1
  • Genco Alfredo
    • 1
  • Giancarlo Micheletto
    • 1
  • Vincenzo Borrelli
    • 1
  • Augusto Veneziani
    • 1
  • Marcello Lucchese
    • 1
  • Marcello Boni
    • 1
  • Simona Civitelli
    • 1
  • Ida Camperchioli
    • 1
  • Vincenzo Pilone
    • 1
  • Maurizio De Luca
    • 1
  • Paolo De Meis
    • 1
  • Massimiliano Cipriano
    • 1
  • Michele Paganelli
    • 1
  • Vincenzo Mancuso
    • 1
  • Angelo Gardinazzi
    • 1
  • Angelo Schettino
    • 1
  • Roberta Maselli
    • 1
  • Pietro Forestieri
    • 1
  1. 1.Italian Group for LapBand, Città della Scienza NaplesItaly
  2. 2.Torre AnnunziataItaly

Personalised recommendations