Late band slippage has occurred in nearly 3–10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin® swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.
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Foletto, M., De Marchi, F., Bernante, P. et al. Late Gastric Pouch Necrosis after Lap-Band®, Treated by an Individualized Conservative Approach. OBES SURG 15, 1487–1490 (2005). https://doi.org/10.1381/096089205774859272
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DOI: https://doi.org/10.1381/096089205774859272