Abstract
Simultaneous gastric band removal and laparoscopic sleeve gastrectomy have gained increasing acceptance recently, however, the risks associated with a single stage revisional approach have yet to be fully delineated. We describe a case of retained adjustable gastric band following elective conversion to a gastric sleeve that was not recognized for over 12 months. The patient subsequently required an operation for band extraction.
Introduction
T
Case Report
A 35-year-old female weighing 93 kg (body mass index [BMI] of 35.5 kg/m2) with hyperlipidemia underwent laparoscopic adjustable gastric banding. Over the subsequent 27 months, she lost 43 kg (BMI 19.2 kg/m2) and underwent an abdominoplasty for removal of redundant skin. She began experiencing symptoms of reflux and epigastric pain when ingesting liquids and solid food approximately 28 months postbanding. Anteroposterior x-ray and upper gastrointestinal series demonstrated malposition of the gastric band with dilatation of the gastric pouch consistent with a slipped band. Her symptoms persisted despite complete deflation of the band. She underwent a laparoscopic gastric band removal along with concomitant laparoscopic sleeve gastrectomy. The operation was performed without difficulty and her postoperative hospital course was unremarkable.
A week following discharge, however, she complained of moderate lower abdominal pain and constipation presenting to an emergency department (ED) 12 days postoperatively for these symptoms. She was otherwise tolerating a full liquid diet without nausea or vomiting. Her blood work was unremarkable. A computerized tomography (CT) scan was obtained and demonstrated intra-abdominal free fluid and a contraceptive device reportedly in proper position (Fig. 1). The patient was discharged from the ED after being told that her symptoms and CT findings were consistent with normal postoperative changes.
Axial and coronal computerized tomography (CT) images of retained gastric band within the abdomen/pelvis approximately 1 month postoperatively.
Over the year, she followed up routinely with her bariatric surgeon every 3 months. She reported intermittent episodes of sharp abdominal pain occurring about once monthly, although these episodes would spontaneously resolve within several hours. She was treated for multiple urinary tract yeast infections during this timespan.
Twelve months after her band removal and gastric sleeve, she presented again to an ED due to 4 days of persistent abdominal cramping and diminished appetite. She denied changes in bowel movements, nausea, or fever. Her vital signs were normal, BMI 22.3 kg/m2, and physical examination positive only for mild tenderness in the right lower abdominal quadrant and suprapubic region. Blood work was again unremarkable. A CT scan, however, demonstrated a foreign object in the pelvis adjacent to the bladder, consistent with a retained gastric band (Fig. 2). The patient was brought to the operating room for extraction of the gastric band.
Coronal CT (one year following initial CT shown in Fig. 1) demonstrating gastric band within the lower abdomen/pelvis.
On laparoscopic examination, a small amount of serous fluid was seen in the pelvis, and the band was adherent to the mesoappendix. The band was freed and extracted in its entirety from a 12-mm port. Because the appendix was potentially devascularized while mobilizing the band from the mesoappendix, an appendectomy was also performed. The patient had an uneventful postoperative course and was discharged 3 days later.
Footnotes
Disclosure Statement
No competing financial interests exist.