Lapband Slippage: Causes & Prevention
A Clinical Study
A clinical study was done in Germany to review complications following lap band surgery. Thirty-five hospitals were involved in the study, with 4138 patients that underwent gastric banding over a five-year period. Lap Band long-term complications were described in 8.6% of all patients. The most common complications included: pouch dilation or enlargement (5.0%), lap band slippage (2.6%), and Lapband migration or erosion (1.0%). (Stroh,C Manger, T “Complications after adjustable gastric banding”, Chirurg, 2006, Vol 77,pag 244-250)
Normal Lap Band X-Ray Under Fluoroscopy
Enlarged Lap Band Pouch
What is Lap Band Slippage?
One of the long-term complications of lap band surgery is called “Lapband slippage” and can be defined as “when the Lapband and the stomach pouch are both prolapsed.” This means that the lap band has shifted position and the enlarged stomach pouch has also shifted or twisted so that food does not go through the lapband into the rest of the stomach. This may result in pain, discomfort, decreased appetite and inability to eat or drink, and vomiting. Lapband Slippage does not happen immediately but may take several months to develop.
Large Lap Band Pouch
Lap Band Slippage generally develops in a progressive manner. As food intake is increased, the stomach begins to stretch and grow and the patient may stop losing weight or start to regain weight. At this point, patients may only exhibit an enlarged stomach Lap band pouch. This can be medically treated by deflating the lap band to release pressure and slow the growth of the pouch (successful in 70% of cases, or surgical treatment can be considered). However, if the enlarged lapband pouch continues to grow, the lapband progressively rotates until both the lap band and the enlarged pouch become prolapsed, resulting in Lap band slippage. This is followed by functional stenosis (narrowing) of the stomach.
Lap Band Slippage
Lapband Slippage Symptoms typically include progressively worsening reflux, vomiting and epigastric complaints, which may increase to sudden near-total dysphagia (inability to swallow or eat anything, including saliva).
Risk factors or causes of lap band slippage include surgical technique, model of the lapband used, early consumption of solid foods, early inflation or filling of the band, consumption of carbonated or sparkling beverages, and frequent vomiting.
Treatment for lap band slippage requires surgical intervention. The lapband must be repositioned or removed, based on the operative findings and condition of the stomach pouch. If appropriate, the surgeon and patient may elect to choose another type of bariatric procedure such as a Gastric Sleeve.
How Do I Prevent Lap Band Slippage?
In order to decrease the risk of developing lap band slippage, it is important to follow the recommended diet following surgery and to avoid introducing solid foods too early. In addition, the fills should not be started before 6 weeks post-operatively and these Lap band fills should be very gradual. We also recommend that fills should be done under fluoroscopy, even if you are asymptomatic (no symptoms of lap band slippage), to be able to monitor the position of the lapband, and the size of the stomach pouch and condition of the esophagus. This will allow for early diagnosis of an enlarged stomach pouch or possible lap band slippage.
Originally posted 2009-02-17 13:25:15. Republished by Blog Post Promoter
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Lap Band surgery has become an increasingly potent tool in the battle against obesity. Though considered as safe and effective as weight loss procedure that is ideal for patients who may face a higher risk of gastric bypass post-op complications. If you have any question or want a detailed consultation regarding Lap bad surgery, meet us at http://www.thebariatric.com
Comment by Melva Gabura — February 19, 2009 @ 7:00 am
Hello,
Many Lap band slippages were seen with the first 3 Inamed models due to the preformed ” C ” shape of the lap band and the high pressure balloon..
Recently, the Realize band has shown an increase in slippage among patients because of been also preformed.
I still like better the Quick Close lap band ( Johnson & Johnson), the one that shows no rigidity at all and has a low pressure balloon.
Comment by Dr. Arturo Rodriguez — October 15, 2009 @ 9:27 pm
If there is a leak in the port can the leaked fluid cause damage or create some kind of pain/discomfort in the abdomen?
Comment by Tim S — November 7, 2009 @ 2:20 pm
Hello,
Some patients can have a sharp pain at the port area when there is a Lap band leak at that level.
The pain respond very well to Tylenol and should not last more than 12 Hrs.
When pain plus inflammatory response are together the patient need to be checked for Lap band erosion.
Comment by Dr. Arturo Rodriguez — November 8, 2009 @ 7:06 pm
i just had my lap band filled 2 days ago, and it is painful to both drink and eat. I can however swallow will this go away as I lose more weight or should I see my doctor?
Comment by Mary — January 16, 2010 @ 1:49 pm
Be just on liquids for couple days taking Maalox and Azantac and if is not a change in what you feel you should have half cc taken out..
Comment by Dr. Arturo Rodriguez — January 16, 2010 @ 3:24 pm
Hi there bandits. My name is Di. I have had my band for 3 yrs. My son who is now 17 has had his for almost 2 and doing well. I have had acid reflux since 6mnths after the band was inserted, so I know all about the waking up in the night almost asperating on gastric fluid, I also get episodes of sore throat and laryngitis. I find that maxalon and buscopan help alleviate these symptoms. I reched my goal weight a year ago and have since had 3cc removed over a period of 9 months, the symptoms I have described to you have been relieved by doing this, and I have only put on 5 kgs… so I think I’m maintaining pretty well, but I cannot go without my chronic medication of nexiam 40mg daily, if i stop this medication it feels as if I’m having a heart attack. I have had 2 gastroscopes when these symptoms have appeared and both times its been a case of food being stuck in the band, but no erosion or prolapse has been found. What I am worried about is the potential for slippage and erosion in the years to come, does anyone have any advice on how to prevent this?
Comment by Dianne — January 17, 2010 @ 4:08 pm
Congratulations Di!!!
I would take 1/2 cc out to prevent complications since you are in your weight now and eating slowly, chewing well and increasing your physical activity will do the rest..
Lap band is working!!!
Comment by Dr. Arturo Rodriguez — January 17, 2010 @ 5:30 pm
My band slipped shortly after surgery. 8 weeks–my first fill. 12 weeks my second fill. I did not experience any of the symptoms of having my eating limited and I began to worry. After my upper gi test, with barium contrast material, found out my band in below my stomach. Stayed true to the diet for the first 6 weeks. What could have caused my band to slip.
Comment by Boise-gal — February 2, 2010 @ 10:04 pm
Hello,
You should have been frequently vomiting in order the band to be slipped in such a short time after surgery.
If is not your case need your band be checked by another doctor.
Also need to know what kind of band you have.
Comment by Dr. Arturo Rodriguez — February 3, 2010 @ 7:56 am
Hi
I have a question I was trying to call my Dr. about but he is away on vacation. Of course self diagnosis on the internet is not good – BUT I was searching and I came across your website which I found very informative. I had the band placed in july of 2008 and I a have so far lost 165 lbs down from 440lbs. I have never had any problems such as vomiting in all this time. I only had minor fills during the first couple of visits to get the band comfortable.
2 days ago I had root canal and the dentist gave me vicodin for the pain. I took it before bed, I had also eaten (possibly a little too fast and too much). In the morning I woke up with pain in the port area. I thought it would go away – I only drank liqueds yesterday, but I had pain throughout the day (not major-like someone punched me in the port area)
Should i stay on liqueds? Any ideas?
Thanks,
Joe
Comment by Joe Robbin — February 3, 2010 @ 12:57 pm
Hello Joe,
You should stay on liquids 3 days plus Maalox e/4 hrs and Zantac e/12 hrs…Pain should go away and in the case is persistent or the port area gets infected you will need to be check for stomach erosion.
Comment by Dr. Arturo Rodriguez — February 4, 2010 @ 4:29 pm
Hello,
I just found out that I have a concentric pouch, due to bieng too tight. I have had the band for almost two years. The Doctor suggested I go on liquids for two weeks, and hopefully the band will re-position itself, and the pouch will get to the size it should be.
So my question is are there any long term complications to leaving the band in place if the band doesnt re-position itself. The Doctor stated that I can leave the band in without getting it re-filled, or that I can have it removed.
He will check me agaoin in two weeks with a barium swallow. And I am somewhat nervouse about the situation I am in.
So please if you can answer my question, about any long term complications with leaving the band in place once you’ve had a concentric pouch.
Thanks in advance,
Nica
Comment by Nica — February 18, 2010 @ 8:35 pm
Hello Nica,
How big is the pouch? I am not concern about a patient having a concentric pouch because only means that is dilated.
By removing fluid should be improvement in the size of the pouch but I would make it to wait 1 month, check and if is OK I start with very litle fills …The Lap Band can stay there without causing any problem…
Comment by Dr. Arturo Rodriguez — February 18, 2010 @ 9:53 pm
Hello Doctor,
Thanks for your response. My Doctor didn’t tell me how big a pouch I have. He showed me that it was enlarged, and the band wasn’t angled. And that is was called a concentric band/pouch. But when he took all the fluid out,the pouch became smaller, and the band changed position where it looked like it had a little bit of an angle. But he said there was a 50/50 chance that it would fully correct itself within a month. So he said I would have the option of taking the band out, or leaving the band without fluid, if it did not correct itself.
This happened three days ago, and I have been on complete fliuds since then. The night coughing, and gerd have completeley stopped. Do you recommend your patients go on a liquid diet for two weeks for this kind of problem? I ask because, I have been doing some searching on the net, and I havent found anything that states it is necessary to do full liquids.
I have lost 60lbs, and need to lose another 10lbs.
Again thanks for taking time to answer my questions!
Nica
Comment by Nica — February 19, 2010 @ 8:33 am
Hi Veronica,
I usually let the patients eat what they want after removing the fluid out.
The pouch will not grow because will be not restriction to allow to be forced.
I do not remove the Lapband because of been concentric or not having the right angle or either re-position the lapband because of this.
I will recommend you to increase your activity and not having the lapband been to tight in the future and these will prevent you from complications.
Comment by Dr. Arturo Rodriguez — February 19, 2010 @ 6:33 pm
Thank you! I have been on liquids for three full days, and have been able to lose 4lbs. So i’m very pleased. I wasn’t sure i’d be able to handle two weeks of only fluids. I think I will try two more days on liquids.
I usually do between 40 to 80 minutes on treadmill. So I will continue that.
I will have to go back to my Doctor in about a month, and see what has happened to my band/pouch.
I hope I can report good news to you then.
Nica
Comment by Nica — February 20, 2010 @ 10:19 am
You will do great Veronica, you will see…
Gracias
Comment by Dr. Arturo Rodriguez — February 20, 2010 @ 4:33 pm