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A5002
Management of Laparoscopic Adjustable Gastric Band Erosion: A Single Institution Experience

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Laparoscopic Adjustable Gastric Band (LAGB)

•First approved for use by FDA in 2001 (by 2004, comprised 1% of bariatric procedures in the US; by 2010, 46%; by 2014, 10%)
•Complications include: port infection, leak, poor weight loss, weight regain, chronic pain/nausea, band migration, and band erosion

Methods

•Retrospective chart review of prospectively maintained database
•January 2007-January 2017
•CPT codes include 43774 (removal of band and port) and 43999 (unlisted/band adjustment)

Results

•96 LAGB removals performed
•14 band erosions identified
•86% female
•Age 35-60
•BMI ranges (at time of removal): 27.6- 58.7
•Interval to removal: 2-14 years

Patient Presentation

•Poor weight loss
•Chronic abdominal pain
•Dysphagia
•Port site infection (fever, erythema, elevated WBC)

Evaluation

•Physical examination
•CT abdomen (IV/oral contrast)
•Upper GI
•Upper endoscopy

Endoscopic Management

•43% (n=6) underwent successful endoscopic removal (still requires surgical removal of port and remainder of tubing)
•3 complete band migrations
•3 partial erosions
•Endoscopic techniques
•Needle knife
•Endoscopic scissors
•Wire cutter
•Emergency lithotripter
•Removal with forceps or snare

Laparoscopic Management

•21% (n=3) underwent up-front laparoscopic removal
•No evidence of erosion on preoperative workup
•Laparoscopic technique
•Adhesiolysis
•Identification of extraluminal band
•Band extraction
•Primary closure (with or without omental patch)
•Port and tubing removal

Failed Endoscopic Management

•29% (n=4) failed endoscopic retrieval, required laparoscopic removal (1 band migration, 3 partial erosions)
•Difficulty cutting, grasping, snaring, and extracting the band
•Extensive fibrosis around the band
•One additional case of combined approach in patient with previous RYGB (not included in any of the above management categories); required laparoscopic mobilization of gastric pouch followed by endoscopic removal of band

Conclusions

•Band erosion is a known complication of LAGB
•The true incidence is unknown, however will likely increase in coming years
•Diagnostic modalities include CT, UGI, and EGD
•Endoscopic removal requires skill and armamentarium of tools for success
•>50% erosion is associated with an increased rate of successful endoscopic removal
•If endoscopic removal fails, laparoscopic removal is indicated
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