Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation
Erosion is a long-term complication of lap band surgery, and occurs when the Gastric Band fastened around the upper stomach gradually erodes into the stomach wall and extends into the gastric lumen. Intragastric Lap Band Erosions have been reported at rates that vary from 0.6% to 10% depending of the operative technique, the doctor’s experience, the device used and the most important factor: the patient’s follow up.
The use of NSAIDS, alcohol and smoking have been proposed as three of the main factors contributing to hyperacidity and irritation of the mucosal layer of the stomach. This important layer prevents us from acquiring ulcers in normal conditions. When the irritation is persistent, it can cause erosion of the wall layers of the stomach, which may allow the lap band to migrate into the stomach (“inside out” erosion theory). Repeated vomiting has also been suggested as a possible accelerant, especially when a high degree of obstruction is present (For example, an over-filling of the lap band). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the Lap Band tubing, causing the tissue under the skin of the Lap Band Port to become infected.
Figure 1.0 Intragrastric Lap Band Migration – Drawing of radiographic findings illustrates passage of liquid contrast material (Barium) around left section of band that has eroded into the stomach (small arrow).
In some cases, Lap-band erosion occurs gradually and may be silent or go unnoticed. However, several clinical symptoms may develop and should raise the suspicion of Lap Band Erosion: (1) cessation of weight loss, (2) weight regain with loss of restriction in the lap band, or (3) a port site infection. The Clinical Symptoms and Radiological or Endoscopic findings depend on the degree of Erosion.
The diagnosis of Lap Band Erosion can be made at the radiological evaluation performed under fluoroscopy during a gastric band adjustment in both symptomatic and asymptomatic patients. If the radiological evaluation does not show signs of lap-band erosion and the patient has the symptoms, the doctor is obligated to perform an Endoscopy.
Lapband Port Infection http://www.thebariatric.com
Figure 1.1 Lap Band Port Infection
Due to the fact that Lap Band Erosions usually open with a port infection (35%), the infection will continue after removal of the port, especially if erosion was not diagnosed. In these cases of chronic infection, further radiological and endoscopic tests are needed to demonstrate the presence of Lap Band Erosion.
Lapband Erosion, http://www.thebariatric.com
Figure 1.2 Endoscopic View of Lap Band Erosion
Lapband Erosion, http://www.thebariatric.com
Figure 1.3 Intragastric Lap Band Erosion – Note the “tips” of a Swedish band into the gastric lumen
Lapband Erosion, http://www.thebariatric.com
Figure 2.0 – Intragastric Lap Band Erosion – Radiological evaluation shows 2 channels of contrast material, instead of one, clearly demonstrated in the later view of Fig. 2.1
Lapband Erosion, http://www.thebariatric.com
Fig. 2.1 – Intragastric Lap Band Erosion - In this lateral view you can see the “bridge” between the upper (the pouch) and the lower stomach, the barium contrast material bypasses the part of the lap band that has eroded through the stomach’s wall.
Lapband Port infection http://www.thebariatric.com
Figure 3.0 - Missing Port – AP plain film shows a lap band without the port. The Patient had a history of port removal secondary to port infection with a persistent infected fluid coming out from the port area.
Lapband Fistulography http://www.thebariatric.com
Figure 3.1 Intragastric Lap Band Erosion demonstrated by fistulography.
Note the injected contrast material at the skin level is going through the fistula into the lower stomach.
The upper GI x-ray does not reveal lap band erosion in its early stages. However, the radiological appearance of late-stage intragastric band erosion on the upper gastrointestinal series is pathognomonic when the “stair sign” is observed. Barium swallow during the upper GI shows a flow of contrast fluid around the portion of the band that has eroded into the stomach. As mentioned before, in cases where the radiological findings are missing, an endoscopic evaluation is mandatory.
Lapband Erosion, http://www.thebariatric.com
Figure 4.0 Intragastric Lap Band Erosion – Radiograph from upper gastrointestinal series shows characteristic appearance of intragastric lap band erosion. Note the liquid contrast material on both sides of penetrating portion of the lap-band, “the stair sign”.
Lapband Erosion, http://www.thebariatric.com
Figure 4.1 - Radiologic evaluation shows a complete eroded gastric band – Note the location of the migrated band; the lap band device is found in its totality intragastric at the level of stomach antrum (the lower stomach). The patient had not been loosing weight for 3 years.
Lapband Erosion, http://www.thebariatric.com
Figure 4.2 – Complete erosion of the gastric band (seen in Figure 4.1) the gastric band was removed by endoscopy
Treatment of lap band erosion requires removing the lapband by laparoscopy or by endoscopy. Weight regain typically occurs following this procedure. However, it is necessary to remove the gastric band in order to avoid further complications. It is recommended to treat Lap Band Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (Lap Band removal). This is due to the high incidence of complications and failures when the procedure is done immediately following removal, or sooner than 6 months after removal, since the portion of stomach that has been eroded is weak and prone to leaking.
It is true that Lap Band Migration means the failure of the operation and leads to a second bariatric procedure; however, erosion is considered a complication with a benign course if it is managed properly.
Originally posted 2008-08-09 23:51:53. Republished by Blog Post Promoter
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Dear Dr Rodriguez
Thank you for your research, it is very helpful. I was banded 2 1/2 years ago but I have not had a fill in 22 months. My experience was fine but I have had band discomfort from the start. From the beginning I have had cramping pain at the band site when I bend over but if I stretch, it resolves within 2 minutes. Recently I have had new pain on the port side which wakes me at night. No vomiting or fever. The pain is around the port and the bottom of my rib cage feels sensitive to the touch The pain radiates around my back. The pain was sporadic at first but is now consistent and feels like an ache but also burns. I thought maybe an infection was the cause but I have no redness or fever. I suffer from autoimmune problems and was thinking here might be inflammation around the area. Thank you for your help
Hello Christy.
The juices you are drinking can be the cause of your lapband problems.
Taking Prilosec and Maalox in a regular basis should help to prevent erosion.
I recommend you to have your lapband check with fluoro since is an old model and has a leak,
Hello Nicole,
Pain as you describe you have could be many things….This pain probably is not related with the lapband but need more tests done to be sure like an Upper endoscopy.
Contrast CT Scan and the PillCam are option to evaluate the small intestine but I am not sure if your insurance do pay for them.
Hello Karen,
Yes, as you say could be an infection or inflammation pain related.
Some of the patients need the lapband port to be removed and place back one month later and that seem to work.
Also placing hot and cold at the port area also helps.
Let me know.
hola dr.
I had lap band surg 6/30/10.I never felt any restrictions and had no feeling of being full.I have had several fills and am at the max cc’s.I have been eating more and more and gaining weight and my stomach is getting big again.I have a bulge near the port and I feel my stomach bulging out at the top and it is hard.I live in Puerto Penasco Sonora and travel to the VA clinic in Tucson Az,and have an appt 8/30 for a physical.
Any suggestions.My wife is nagging me..Thanks
Hello Rob,
I recommend you to have a fill under fluoroscopic view to check the lapband status and to have the answers of what is happening to you.
You need to know the brand of the lapband and the size of balloon so ask your doctor about that. Some of the lapband models never work and some other have never been approved.
Let me know.
I am trying to get my records from the dr in Colorado and so I don’t know the size or type.I will give the dr at the VA this info and see where it goes from there.
I voiced my concerns to them and all they did was fill some more and I never noticed the difference.
I am 68 years old and it has become a real concern to us now.
Thanks Rob
Hello Nicole,
I need to know how tight is your lapband, how many cc’s do you have?
Are you vomiting sometimes?
Please Dr. can you answer my question???
i had my lap band from six year , i was livivng in syrie beacause of the war their i moved from one year to usa i don`t have any assurance ..and from six month i felt my left side breast hurt and my lap band was hurt too but from one week paiful..please dr if you caan give me over the counter medecine for my port infection..i think this wht i have .. by the way my vegiana was burning from one year and i did the test in syrie they said every thing clean ..but now my urine very yellow i think from my port infection too…please if you give me any antibiotic over the counter make me feel better ..please i need help
Hello Wardeh,
There is not an antibiotic you can get over the counter in the states but port infection is obvious when is red, swollen and painful and you don’t say you have that.
In case you have a port infection, the antibiotics will not be helpful. The port has to be removed in order to cure the area.
Port infection is cause mostly when you have lapband erosion. So you need to be check for lapband erosion when you face or are suspicious about port infection.
You can get Vitamin C for urinary infection over the counter and that could help.
I had the lap band surgery in May 2011. The port became infected and was removed in July. A new port was replaced on the opposite side in November. Now, a month later, I’m in for my first fill ever. Instead, 2cc’s of yellow fluid was aspirated. Unlike the first port site, the second one healed properly showing no indication of infection. Could this also be infected? Should the Dr. Have known whether the band itself had eroded?
Hello Mocha,
I think the fluid is yellow because some blood contaminations or the lapband system was not flush and clean when placing the new port.
I would’t worry too much about it.