Lap Band Leaks: What You Should Know
A Lapband leak is suspected when a patient that previously had adequate restriction feels a change in the amount of restriction. This can happen suddenly or over a period of time, depending on the size of the leak. If there is a leak of the lap band, the band will not be able to be adequately filled and will not provide restriction, or function properly. There are four types of lapband leaks that can occur to the lapband once it is placed, based on the location: (1) Leaks at the lapband balloon, (2) Leaks at the lapband tube connections, (3) Leaks at the body of the tube, and (4) Port membrane leaks.
(1) Leaks at the Lapband Balloon
Leaks in the lap band balloon can be unintentionally caused by needle punctures during surgery, or may occur over time in certain factory weak points of the balloon.
Leak at Lapband balloon http://www.thebariatric.com
Figure 1.0 In the figure above, you can see the lap band (white rectangular shape), which has been filled with contrast fluid. The arrow points to a small amount of fluid that has moved outside the band from a small leak in the balloon of the lap band (VG).
Lap-Band Leak http://www.thebariatric.com
Figure 1.1 This is another image of a lap band balloon leak. A thin line of contrast fluid can be seen outside of the lap band, surrounding both the band and the tube.
Lapband Leak http://www.thebariatric.com
Figure 1.2 The lap band balloon can be seen in the centre of this image (rectangular shape, slanted to the left). In this case, there is a larger leak of contrast fluid which is more easily visible around the lap band balloon (arrow).
Lapband leak seen during surgery http://www.thebariatric.com
Figure 1.3 In this case, there was a leak in the lap band balloon, and surgery was required to remove the band. During surgery, the leak was very clearly seen when fluid was pushed through the lap band, to reveal the location of the leak. (The arrow points to the line of fluid leaking from the AMI band).
(2) Leaks at the Lapband Tube Connection
Leaks can occur within the Lapband tube connection if there is a break or fracture of the tube next to the metal connector. Breaks or fractures may be due to physical movement over time, when considering the materials of the connections (metal and silicone). If the “fracture” is complete, it can be easily diagnosed with an x-ray film (plain film), without needing to inject contrast fluid.
Lapband plain x-ray film http://www.thebariatric.com
Figure 2.0 Above, we can see the lapband port in the lower, right corner, with the tube extending to the left in the x-ray image. There is a complete fracture (break) in the tube. The distal end of the tube is near the port, which means the tube may still be in the abdominal wall.
Lapband Leak http://www.thebariatric.com
Figure 2.1 Above, we can see the lapband port near the bottom of the x-ray image, with a complete fracture (break) in the tube, which is curled up at the top of the image. This shows that the tube is likely still inside the abdominal cavity.
Port of a Lapband leak http://www.thebariatric.com
Figure 2.2 Above is a photo of the lapband port that was removed during surgery from Figure 2.1.
If the “fracture” is incomplete, it is necessary to inject contrast inside the system in order to diagnosis the problem.
Figure 2.3 This shows an incomplete fracture, with the tube in place.
Port of a Lapband leak http://www.thebariatric.com
Figure 2.4 This is the port removed from the above case (Figure 2.3).
Port of a Lapband leak http://www.thebariatric.com
Figure 2.5 In this plain x-ray film, the port can be seen in the bottom right corner. There is a slight bend in the tube at the connection point (upper right corner of the film).
Figure 2.6 As a leak was suspected, contrast fluid was passed through this lapband port. A large amount of contrast fluid is seen at the bend, in the top right (the connection point).
In some cases, it is not possible to indentify a leak with x-rays. Therefore, the diagnosis of a leak may need to be done at the time of surgery.
Lap-Band Leak http://www.thebariatric.com
Figure 2.7 In this x-ray with contrast fluid, there is no evidence of a leak.
Tube leak near the port http://www.thebariatric.com
Figure 2.8 This leak was not demonstrated with x-rays. As the leak was suspected, surgery was required to find the location of the leak.
(3) Leaks at the Body of the Tube
These lap band leaks are usually iatrogenic. This means that the leak was caused by an unintentional needle puncture, during a fill that was done without using fluoroscopy to guide the needle. These kinds of leaks are very common in office fills. Even in the best hands, there is always a risk of puncturing the tube during a lap band adjustment. This is one of the reasons that we always recommend fills to be done under fluoroscopy.
Lapband tube puncture http://www.thebariatric.com
Figure 3.0 A leak can be seen in the body of the tube, close to the connection. This leak was made with a needle at the time of an adjustment (office fill).
Lap-band Tube puncture http://www.thebariatric.com
Figure 3.1 The leaking portion of the tube was removed during surgery.
(4) Port Membrane Leaks
This type of leak usually occurs when the patient has received many fills, or when the adjustment was done using a standard needle. Only Huber (non-coring) needles (Figure 4.2) should be used to perform fills or adjustments. The silicone membrane of the port may be damaged if any other type of needle is used.
Lap-band Port Leak http://www.thebariatric.com
Figure 4.0 The lapband leak is just in front of the port, where contrast can be seen.
Lap-band Port Membrane Leak http://www.thebariatric.com
Huber Needle http://www.thebariatric.com
Figure 4.1 During surgery, we can see a leak at the port membrane as seen by the bubbles that are produced when the port is placed in water.
Figure 4.2 Huber (non-coring) needle.
Final Thoughts
Every day, the lap band manufacturers are improving the design and functionality of the gastric bands in order to prevent complications such as leaks. However, there is always a small risk of leaks over time. Many types of lap band leaks can be avoided by careful handelling the gastric band at the time of the surgery and by doing the lap band fill or adjustment under the fluoroscopy guide, and finally by using the right non-core needle.
Originally posted 2009-03-07 23:31:38. Republished by Blog Post Promoter
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Hello Tonya,
Lapband leaking usually comes from the port to the hose connection so it is easy to have it repair.
If you are thinking in having it repair by us send an email to md@thebariatric.com
Hello Cassie,
No, I have never seen one leaking without changing the saline color but any way you need to check for not losing the restriction you have now.
Thank you for your comments about me. Happy New 2012.
Hello Dr.
I had my lap band placed 9/30/2011, my question is, i dont feel any restriction, i still feel ” unbanded” i have had 2 fills, i have a 10cc band. at the last fill 1/4/2012, when she filled my band (in the office) there was alot of bubbling sounds.. i could hear it definatively in my body. does this mean i may have a leak?
why could i not be feeling any restriction after the 1st few days?
thank you
live in CA unemployed need a doctor to replace port due to severe leakage/gained 100lbs
need help
Hello Dana,
Was your fill done under fluoro? How many cc’s had you have totally?
Let me know because it’s important to give you my opinion.
Hello Marilyn,
What kind of lapband do you have?
Hello Dr,
I have had my band for about 6 years now and has been working wonderfully on 7.5ml fill. Now my band has stopped working and I am putting on weight fast. I just had an endoscopy to check that it wasnt sitting inside the stomach. the Dr said everything looked normal. The band now has a total of 9 ml in it and I was wondering, is it possible for the saline to be sitting inside the tube and not in the ballon? Could a valve have collapsed so the saline isnt staying in the ballon?
Hello Sue,
It is not possible to have a collapsed lapband port and the tube can’t hold more than .5 cc
It is more frequent to see an enlarged pouches and not to be able to feel the same restriction because of that.
Hello Dr
I had a band fitted 3 years ago. Up until about November last year it worked wonders and I lost almost 80kgs. In November for some reason it started to not work – I’d go to the surgeon and he’d fill it and the restriction would barely last a couple of days. I eventually went and saw the surgeon direct who took me for an xray but they couldn’t find a leak anywhere so I went back for another fill and it showed that I had lost 2cc in 2 weeks. They then put in thicker fluid and it still seemed to be disappearing but a further xray and subsequent CT scan showed no leak. My surgeon has basically thrown his hands in the air and says that he doesn’t know what the problem is. This is fine for him however I’ve put on also 18kg since November. I worked so hard to get to where I was and want to know there is some way to work towards a solution. Any ideas?
Hello Rachel,
First of all, do always your lapband fills under fluoro.
I have found that many times the lapband port is not reach and the saline is injected in the surroundings.
What kind of Lapband do you have? Usually most leaking are find close to the port specially if they placed you an old lapband model.
Is your doctor familiar with lapband adjustments and for detecting erosions?
Since it’s a slow leak, injecting dilute contrast (10:1) and getting a delayed CT (after a few hours) may show the source. CT’s are much more sensitive to seeing contrast material that is leaking.
Hello George,
You are probably right George about using a CT when looking for a leak but what I do is during a fill I use Iopamiro and by injecting the substance I increase the pressure inside the lapband system and look close for leaking at the port itself, the connection between the port with the hose and 10 cm after the port.
Leaks at the balloon area after so many years are just find “rare” because they are usually cause by punters during surgery.
I have had my lapban for two years now and it has leaked sence day one. I just had my first fill under fluoro . He thinks there is a small leak in the ban.
so myDoctor put a thicker fluid in the ban and will check in about 6 weeks. I have a 10 cc ban and he put 8.5 cc in.
If I want the ban replaced, how should pay for the surgery? I have already paid alot of money for this not to work onece. If the it was punchured during instalation by the surgerion, Should the doctor make things right and replace or remove the ban at his cost?
Hello Jerry,
You need to be sure where the lapband leak is. Many times the leak it is at the level of the lapband port so there is not need to replace the Lapband or to have a laparoscopic surgery.
Your doctor should do the lapband fill under fluoro using a dye to detect the leaking’s level.
Hi Doc,
I had lapband 5 years ago… I have lost 127 pounds at goal weight. I had a first leak at 6 months and repaired. No problems until now another leak. I have already paid for first surgery and first leak. I don’t think its fair to pay again for second leak. I have worked my butt off. I didn’t do anything to cause a leak. Why and what happens why am I leaking AGAIN. I’m so frustrated. I can’t afford more surgery. At what poing its it the makers of Lap Band? thank you
Hello Cheri,
Some of the old lapband ports were prone to break and leak at the connection with the hose and they changed the lapband port design.
There are other causes of lapband leak at the port area and one of them is the office fills where the needle can damage the hose.
The first step is to evaluate the level of the leak and to fix it re-locating the port and removing couple inches from the hose.
Hey Dr Rodriguez,
To have a repair to the port or the tub near the port is surgery under Anastasia required? Or is this something that can be done in the office?
Hi Kim,
The lapband port repair for leaking can be done under local anesthesia and sedatives and can be done at the doctor’s office specially if the doctor is experienced in this kind of problems.