Lap Band Erosion
There are many terms that have become familiar to the lap band population because they are commonly used among doctors and patients. One popular term is “Lap Band” which stands for Laparoscopic Gastric Banding. The term “Lap Band Erosion” also became very popular among the banded patients as lap band message boards increased in popularity. The patients that already had the Lap Band were concerned as“erosion” was often connected to topics such as de-banding or surgical removal of the band. However, the term actually means that the stomach has developed a penetrating ulcer and has eroded (worn away) towards the balloon of the band.
How does Stomach Erosion happen in Lap Band Patients?
Intragastric band erosions have been reported at rates that vary from 3 to 10% depending on the operatory technique or surgeon´s experience, the device used and the patient’s eating behavior. There are several different and controversial theories for the cause of erosion:
- The Lap Band around the stomach gradually erodes into the stomach wall over time, and goes into the gastric lumen, as we have seen with other intrabdominal devices.
- The stomach damage done during the Lap Band procedure debilitates the layers of the stomach wall, resulting in erosion at a later time.
- The sutures were placed too deep and trespassed all the wall layers of the stomach, causing micro perforations that generate leaking, infection and later erosion.
- Events that happens inside the stomach, such as frequent vomiting, medications, ingestion of irritants as spicy or hot food, alcohol, etc. as well as a large adjustment to the band system, will produce an ulcer that penetrates toward the balloon of the band.
I believe the last theory is the most consistent and also the most frequently seen in the vast majority of patients with erosion. Other theories, such as a crease or a fold in the balloon, which may harm and erode the stomach lining, were not scientifically proven. We have seen erosion with all kinds of Lap Bands and with all kinds of balloons and find no correlation with the fold theory.
Once the erosion-ulcer is established it is not possible to cure the ulcer, not even by removing all the fluid in the band. Therefore the need to remove the band itself becomes imperative. I recommend the band be removed AS SOON AS POSSIBLE, not because this is an emergency in any way, but because there is a risk of increasing the ulcer’s size. Removing the Lap band can help to decrease the risk of complications such as infection traveling along the hose to the port and to the skin, or stomach bleeding.
How Can Lap Band Erosion be Prevented?
There are several ways to prevent erosion. The first way that I personally recommend is to avoid “large fills” to the Lap Band, in order to prevent vomiting or gastric reflux. The second way that I recommend is to protect the stomach with anti-acids frequently, especially at bed time. The third recommendation is to avoid alcohol, hot or spicy food, vinegar, soy sauce, and coffee. Talk with your Doctor about the medications you are actually taking and ask about exchanging the ones that can hurt your stomach for others with the same effect but less stomach irriation.
Arturo Rodriguez,MD
Bariatric Surgeon
http://www.thebariatric.com
Originally posted 2008-06-12 21:18:18. Republished by Blog Post Promoter
Did you like this? If so, please bookmark it,Tags: De-banding, Health, Lap Band erosion, Lap Band Failure, Port Infection, Stomach erosion
Hello Julie,
Surgical trauma, infection of the patient at the time of the surgery, contamination of the lapband at the time of placing the lapband because of poor handeling, lapband old models that were very small, surgeon experience, etc…
Hello
Thank you so much for taking the time to reply!
Throughout the 3 months I had the band I had blood tests and stool samples and never any sign of infection. I also had a second laparoscopy, where my surgeon removed necrotic fat from under the band but left the band. He maintains there was no reason for the band to be so tight – but whenever I tried actual food (massively chewed) it would close up completely.
I just can’t help wondering if there was anything at all I could have done to cause this… I’m sure I followed the rules, but I can’t find any other cases of erosion within 3 months!
I find your articles and advice most informative – thank you!
Many thanks again,
Julie
Hello Julie,
Using electro-cautery during lapband surgery can leave necrotic fat tissue around or close to where the lapband is placed. Then a “secondary” infection of that necrotic tissue is easily found ann can take you to what you had.
Thank you for likening my articles, they come from 17 years experience in lapband surgery.
Thank you for your prompt reply! 17 years – I bet you have seen some changes in procedure over the years!
Sorry, I feel as though I am being a bit dim (!) but if I had an infection would there not be symptoms of it? What would cause that infection in the first instance?
I suppose what I’m getting at is ‘did my surgeon mess up?’ I’m not interested in pursuing a compensation claim (I used to be a lawyer and saw too much of that!) I just want to make some sense of this.
Sorry to take up so much of your time … but do you know of any relevant case studies I could read?
Thank you again
Julie,
It will be very difficult to know and demonstrate what cause the first infection in your case but the most frequent cause seen is that contamination of the device during surgery causes lapband infection and in a longer term stomach erosion is the cause as I wrote about it.
I think that in your case the necrotic tissue you had favored the infection you developed few days later and also, probably on-proper drainage of the area also left infection around there for to be de-banded 3 months later.
On the other hand, some patients with immune depression can also show infection.
There are not many doctors that write and published about these kind of complications.
Hello
Thank you so much again for all your input – greatly appreciated and a real asset to the internet!
Kind regards
Julie
Thank you so much Julie,
I don’t get comments like yours very often.
Hi Dr. Arturo,
I was wondering if you could help me. I had a fill on Monday and everything went fine with it. I took an iron pill yesterday and think it irritated my stomach by getting stuck. My stoma was very swollen, to the extent that drinking water is difficult. I can get it down, but only if I lay down. My question is, how long can my stoma remain swollen and is it normal to still be experiencing this almost 20 hours later? My surgeon’s entire office is out of town for the next week (at some convention or something in FL) and if I have to have an unfill of any kind would have to go to the emergency room for a complete unfill (which I do NOT want to do). Please help!
Thank you so much for your help.
Hello Nicole,
I do not recommend vitamins or iron tablets in lapband patients because will irritate the pouch and the stoma.
Antacids might help but to do an unfill will be better.
I have been suffering with upset stomach issues for 2 years, but the first two years of the lapband were fine. I have now gained most of my weight back, as I cannot have the band filled. When it is filled, I get a miserable upset stomach, that is immediately relieved from removing the fluid. The Dr. says my ulcer is gone, if so, then why can’t I fill my band, so that I can lose wieght again?
Hello mary,
Have you have an UGI to check your lapband status?
What kind and size of Lapband do you have?
What are the medications you are taking actually?
I need all the info you can give me to give you my thoughts about it.
Thanks
I had a band put on in February 2011. I initially lost 20 lbs, and I went for a fill in may and have only lost 8 lbs since then, but I haven’t been remembering not to drink liquids with food. I have been better in the last week or so. In the last few days, I have a pinching feeling when I bend at the waist and sit. I also feel a hardened ball that is tender to the touch right to around my port area. It is about the size of a plum. It seems now you can even see it vaguely in the mirror because it protrudes a little. Do I have a slip or erosion or some other complication?
Hello Anita,
I would recommend you to have the lapband port been checked.
In the mean time, hot and cold in the area helps.
I had erosion and the band removed and now of course I’m gaining my weight back rapidly. I want the band put back and my doctor said I could but to wait 6 months for the stomach to completely heal. What is the chance for erosion recurrance and/or success the second time around.
Hello Cindi,
Most of the patients have learned to behave (talking about eating or drinking) after they were de-banded on what no to do for the 2nd lapband and they do well.
I wish there was more information about how to behave. I had no idea coffee, alchol and spicy food could do so much damage. I also think I might have been filled too tight but my doctor said this would not be the culprit. Is there a good place to go to get a spcific diet healthy to a band?
I have had a very successful lap band surgery done approximately 6-7 years ago, I lost about 60 pounds and it has stayed off except for an occassional 6 pound gain or loss from time to time, an amount that is easy for me to achieve a loss without a fill. I have been very lucky in that it only took about 3 fills to acheive my goal.
Here is my question, I have noticed if I eat anything very late, like a snack of any kind before bedtime, after several hours of sleep, and not until halfway through my night of sleep, I will wake up coughing and it is obviously caused because of the food NOT digesting. My biggest concern could that cause any problems of erosion, or problems to my esophagus and why does it occur to begin with, and especially hours into my sleep pattern? I am not eating a big meal and going to bed, it’s normally something very small. Obviously, something I should avoid altogether but was worried about damage down the road.
Thank you so much….this is the first time I have been on this site and have seen how the response come back so quickly.
Julianna
Hello Julianna,
You should be concern in having an enlarged esophagus or enlarge lapband pouch.
I recommend you to have a barium swallow and have the lapband checked and if there is any sign on having enlarged pouch to remove some of the lapband fluid.
Hello Dr.,
My sister recently went through debanding due to erosion. The Dr. stated she would no longer be a canidate for the banding but did not say why. Also he said that sometimes scar tissue will form and it will create a band around the stomach so she may not need to do anything further, i.e. bypass….is this true? Also, do you know of any ongoing complications that she may have due to the erosion.
Thank you so much for any advice!
Hello Deborah,
Some patients due to the scar tissue they form are not good candidates for re-banding or for doing a gastric bypass safely.
What I do is to check the options laparoscopically 6 months after the debanding. Some times it is feasible to place another lapband, and in cases that is impossible to placed back I like to do a gastric sleeve instead.
Thank you so much Dr. for your recommendations. One more question….do you know of the long term effects of the erosion…i.e. could the scar tissue that forms be so much that additional surgery is needed to remove the scar tissue or do you know of any other future complications?
Thanks again!!!
Hello doctor. I have this weird feeling in my stomach. Like a dull ache/pain but not unbearable just irritating..it feels like how the chest feels when u take a deep breath in the freezing cold. I’m sry I don’t know how to describe it. What could this possibly be? I thought erosion but don’t have a loss of restriction (only through my unfill 3 months ago) and my port is inplace. I don’t have any issues of food getting stuck or pbing. I have a 10cc band and I have 5 ccs in now.I was at 6.5 but that was way too tight and went bacl down to 5ccs. I have a hard time going to my doctor because he is so rude. Since my unfil I gained 14lbs abd I know he will give me a hard time. What could this be? Oh also it seems to feel better after I eat and is mainly in the morning when I get this feeling. Please help!
Hello deborath,
I haven’t have or known of any surgery needed besides the debanding for patients with erosion.
The scar that forms in the upper part of the stomach do not cause ‘mechanical’ problems to the GI function.
I don’t expect further complications after a debanding surgery. The surgeons should expect difficulties during a second bariatric procedure and complications as leaking are more frequent when doing a gastric bypass.
Hello Christina,
I will recommend you to take Maalox e /4 hrs and an acid blocker e /12 hrs.
You need to quit coffee, coke or any other gastric irritant as alcohol, hot food or vinegar.
If you still have pain after taking the medication you will need to take out all the saline for 1 month.
I rarely drink coffee and never drink soda..for alcohol I do drink wine coolers or a glass of wine 2 or 3 times a week. No more alcohol at all? And its not really pain its just an akward feeling which I haven’t had today at all.I had oatmeal and a teapoon of peanut butter for brkfst.and so far I’m good. Right now I’m takin just generic acid blockers and occassionally prilosec otc. It seems I only have this akward feeling when I don’t have any food in my stomach
Hello Christina,
No more alcohol “for while” until that feeling is gone….
What the heck could it be? It freaks me out..I just left the gym and drank water and the feeling came back for about 10 minutes but only happens iif I take a deep breath in and also hungry at the same time..so weird!! I also use a primatine mist inhaler so maybe that?? Could tis be a symptom of erosion? I know it isn’t slippage bc I have bo “stuck” issues..I wish I had a doctor I could go to that I’m comfortable with. And I also have horrible anxiety and need a cript for some ativan bc that jus makes me relax and to stop thinking about my band and stressing something is wrong all the time! I’m sorry I jus don’t know anybody with the band and my doctor isn’t helpful AT ALL!!!
Hello Christine,
Where are you located? You need to have with you Maalox or pepto like in cases you feel this way.
I definetly think is something you are drinking or eating and of course to be stressed do not help at all.
Let me know.
I live in victorville.california. yes I will go get maalox and what would be the best acid blocker? Yes I can’t help but stress..I’m always worried that something is wrong with the band but I don’t have any serious issues just this weird feeling. I know for sure I don’t want 2 go tighter if I don’t have to.I know 5ccs is not a lot 2 have in the band but it gives me just enough restirction to where I’m able 2 eat ie. Oatmeal 4 breakfast..snack (1 hardboiled egg or a veggie) then lunch (tuna or chicken salad) then snack 1 hardboiled egg or veggie then either a protein shake or a half chkn breast for dinner. I’m trying 2 boost my metabolism.and I also work out 4 days a week. For 1.5_2 hrs a day. Does this sound reasonable? My personal trainer gave m these ideas for meals since I don’t want 2 be too too tight..bc it seems like when I am I’m miserable and can hardly drink water. Sometimes I feel as if I’m the only person who EVER feels this way!
Ps..I only drink water..tea..or crystal light..I do not drink juice or soda. And of course the occassional glass of wine (my job is very stressful) once to three times a week..thanks so much
Hi Christina,
I had a patient that crystal light was causing her the lapband problems but other patients didn’t complain about it.
Why are you having a protein shake? Lapband patients do not need neither proteins or vitamins at all.
My doctor said to take protein shakes and so did my trainer 4 optimal weight loss..I guess a high protein diet is what I need..or that could be a replacement for the grams of protein I need daily? Is tere any way u can email me a diet regimen? It appears I was givin wrong information and maybe that’s y i m not losing even with alittle restriction. And I will stop the crystal light and see if that help as well. Is it normal 4 patient 2 take a while 2 adjust to the band? Its been almost 2 years and only 60lbs..I am 5’8 and weighed 206 until I loosend my band and now I am at 217. I seriously need some help
My email is: md@thebariatric.com
Protein shakes give you extra calories. Your calories should be in your food either the proteins.
I like protein diets but the ones that comes with food.
I will loved to help you…That is why I became a doctor….
Great! My email is mjcb426@yahoo.com..I would love a diet regimen to follow bc at this point id rather not get the band tighter but have justh the little restriction and eat healthy and keep working out. So u can send that to my personal email and I now have yours saved as well
Hello Dr Rodriguez
After band erosion would I be able to have another WLS procedure?
Hello Marcia,
Yes, you can have another weight loss procedure done.
Depending on scar tissue at the stomach area after an erosion you can have another lapband or to have a gastric plication, gastric sleeve or a bypass.
Is removing the molina band painfull?
Hello Mary,
Removing gastric bands of any kind is not painful since is done with the laparoscope.
I had a lap band fitted in the UK just over 3 years ago. After 12 months I had to take some painkillers for my back and started vomitting. I didnt for one moment think it was the band, just assumed the tablets had got stuck. I ended up in hospital and after 7 days they decided the band had slipped. Luckily I didnt have too much damage (or so they said) to the stomach and they re-sited it. Since then I’ve had little restriction, portion sizes have increased, I’ve put on weight and become anaemic. I had an endoscopy yesterday and found out the band has eroded into my stomach. I’ve had no pain or other symptoms and the band was only half full. I’ve been told it has to come out and I wont be able to have another procedure. Looking at your last message, does this mean there’s hope still for a bypass?
Hello Helen,
Your Lapband has to come out because of the stomach erosion.
It is not wise to have a bariatric procedure like Gastric Bypass or Gastric Sleeve at the same time that the de-banding because an important increase of complications.
You will need to wait 6 months after de-banding to start thinking about another procedure.
I like to go first for the Gastric Sleeve rather the Gastric Bypass after de-banding.
So grateful for your website, reading info. on others having gone through the discomfort of possible erosion of a I think is a Molina band. The surgeon I had past away and now I’m desperate for help, I feel all alone with no one to help. I have no insurance so I will have to pay out of pocket,hope I can find someone that can take me on. I recently had an upper GI to see what’s going on. I can’t sleep, eat or drink much. Worried I’ll become dehydrated, so I force myself to drink Glucerna shakes and water. I’m always vomiting and my stomach is inflammed. I suffer from depression due to my condition. I’m almost 60 years old and worried about surgery and the out come. Please give me advice.
Hello Rebecca,
You have to take acid blockers, to stay on liquid diet for few days and to quit Glucerna also for while.
Vomiting will worsened the inflammation of the stomach so preventing that condition will be very helpful to you.
I am assuming that the upper GI was found normal without slippage and having some saline removed will help you eat better also.
Hello – I am American and have currently moved to Germany – I have had a lap band for about 6 years and no problems, last year it slipped and I had to have it repaired and the port was moved to a different spot. Now about 1 year later I am having port problems – like it is protruding out of my stomach much like a hernia – at the same time I feel swollen, like pressure or fluid in my left side – and it gets worse as the day goes on – its not painful just uncomfortable – today my port has a bubble of fluid on my scar -I have had a blood test and come up negative for any type of infection, but i feel something is not right – I am trying to locate a lap band doctor in my town but not having much luck – and I am starting to get worried – should I be worried ? and can this swelling or pressure feeling be caused by my port issues ?
Hello Stacey,
You need a barium swallow to be sure there is not a lapband erosion.
Port problems are frequent after re-locating to a new place.
When lapband ports protrudes and is kind of flipping from its original position should be relocated again or to be pull out.
Some of the patients have to stay without a port for a month and then put it back.
Hi Dr Rodriquez,
I’m so glad I found this. I have so many questions. I was told that my band eroded into my stomach but wasnt really given much other information. After some research on my own, I found out that I was never suppose to be taking ibuprophen, which I was…and quite a bit after I had my baby due to back problems. it was after this that I found out that my band had eroded. I had the fluid taken out while I was pregnant due to heartburn. About 4 weeks after I delivered, I started getting fills again and at first I noticed good restriction but after my second fill, I didnt notice anything different so I decided to go to a different doctor because I’ve never really been a big fan of mine and they are the ones that decided to do a barium swallow and told me i had eroeded. Anyway, longer story short, I cannot afford to have it taken out (I was a cash pay initially and have since lost my job/insurance…not that it would have paid for anything anyway). I’ve lived with it eroded for almost 3 years with only minimal problems but I’m always scared that it will perforate my stomach and I will get really sick (or worse). Is this possible? And is it possible that my use of ibuprophen caused the erosion? Thank you so much for this forum and for being so open and available to us banders! Sincerely, Jeannie Jones St. Joseph, Missouri
Hello Dr.
I had the lap band surgery in 2006 and never got a fill until last Nov. 10′. I was 225 and dropped down to 150 by September. They filled me 1cc once a month until May I was at 8cc. I started experiencing bad acid reflux, vomiting pretty much after every meal and waking up in the night coughing up and vomiting my food or acid depending on if I ate or not. That went on until about September before I finally went and had them take some out about 2cc. I had lost so much weight I was scared if they loosened it I would gain weight back. I felt better vomiting less but still needing to eat tums constantly and take prolosec. I gained 10 pounds but stayed right at 160 ever since. Now on Christmas Eve I started having severe pain in my stomach and chest along with a high temperature. It hurts to eat, breathe, even drink water. I thought it was a flu and tried to fight it until the pain was so unbearable. I went to the hospital on Christmas and they did all types of tests. I had no idea it was my lap band I thought I was having a heart-attack and I’m only 26. All the tests seemed normal except in the catscan they said I had food or fluid up to my neck and wasn’t going down. They released me and yesterday I saw my surgeon and he deflated me completely and said I would get better. I am still experiencing extreme pain constantly and nothing goes down without burning severely. I am having no restriction but can hardly stand the pain. It seems like my surgeon doesn’t seem to think its that serious and it will go away, but I am freaked out since I have never experienced this much pain in my life. Will this just go away or is it more serious? I know I have serious esophagus damage from vomiting. Could it just be irritated or could my band have slipped or erodided? Thank you!
Hello Jeannie,
Lapband erosion is small at the initial face but in later stages can become a large erosion and the lapband can be found totally inside the stomach lumen.
Ibuprofen and other meds can hurt the stomach of lap banded patients but also frequent vomiting, some vitamins, iron and large fills.
I recommend you to have the lapband removal as a priority in your life since you were diagnose already 3 years ago and at some point you could have an emergency surgery for different reasons.
Worries me also that a general surgeon without enough experience in de-banding could be doing an open surgery instead of a laparoscopic one.
Hello Amber,
The esophageal pain resembles the heart pain…You need a endoscopy for evaluating the severity of the irritation.
I recommend you to have Maalox 2 table spoons e/4 hrs while awake and any acid blocker e/12 hrs.
Dieting and choosing food and beverages without irritants is also beneficial to you.
If your Molina band has not eroaded can you have it removed and gastric sleeve done in one surgery and I have coughing reflux could this be caused by the band
Is it difficult to remove a Molina band. What are some of the issues. Can this band be revised to the sleeve and does it have to be 2 surgeries?