Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

LapBand 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 LapBand 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 lapband 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 lapband). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the LapBand tubing, causing the tissue under the skin of the LapBand Port to become infected.

 intragastric-lapband-migration
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 LapBand Erosion can be made at the radiological evaluation performedunder 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.

port-infection

Lapband Port Infection http://www.thebariatric.com

Figure 1.1  LapBand Port Infection

Due to the fact that LapBand 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 LapBand Erosion.

endoscopy-findings1

Lapband Erosion, http://www.thebariatric.com

Figure 1.2  Endoscopic View of LapBand Erosion

endoscopy-findings-tips2

Lapband Erosion, http://www.thebariatric.com

Figure 1.3 Intragastric LapBand Erosion – Note the “tips” of a Swedish band into the gastric lumen

erosion-xray

Lapband Erosion, http://www.thebariatric.com

Figure 2.0 – Intragastric LapBand Erosion – Radiological evaluation shows 2 channels of contrast material, instead of one, clearly demonstrated in the later view of Fig. 2.1

erosion-xray2

Lapband Erosion, http://www.thebariatric.com

Fig. 2.1 – Intragastric LapBand 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.

missing-port

Lapband Port infection http://www.thebariatric.com

Figure 3.0 - Missing PortAP 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.

fistulography

Lapband Fistulography http://www.thebariatric.com

Figure 3.1 Intragastric LapBand 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 itsearly 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 aroundthe 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.

stair-sign

Lapband Erosion, http://www.thebariatric.com

Figure 4.0 Intragastric LapBand Erosion – Radiograph from upper gastrointestinal series shows characteristic appearance of intragastric lapband erosion. Note the liquid contrast material on both sides of penetrating portion of the lap-band, “the stair sign”.

 

band-migrated

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 lapband 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.

band

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 lapband 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 LapBand Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (LapBand 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 LapBand 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.

Susana González M.D.

Radiologist

Arturo Rodriguez MD

Bariatric Surgeon

http://www.thebariatric.com

 

 

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129 Responses to “Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation”

  1. martha says:

    FYI..after several weeks of LLQ pain, many tests, many dr visits, with dr’s being dumbfounded…it was verified that the tubing from the band to the port was fractured. It was seen on the CT, but the physician did an upper GI..and said everything was fine. After reviewing with other physicians, my daughter requested it be totally removed. Amazingly the tubing was totally shredded and had never happened in the area it happened. Half way between the port and the band.
    Has anyone else had or heard of this before. The company is reviewing and testing the band that was removed. All I could find re fractures, was at the port area. Please let me know if anyone has heard of this.

  2. Hello Martha,
    What kind of Lapband did you have?
    Some hose fractures have been caused by improper handeling of the lapband during surgery.

  3. Diana says:

    I am not sure what is going on with me, I have alot of vomiting and somedays are worse than others I can’t eat or drink anything. There are some days that I can.I usually vomit at least one time aday. I know that is not good but i need to see if anyone has any suggestions on what might be going on. I have had my lapband for 2 years.

  4. Hello Diana,
    Been vomiting as frequently as you do will give you problems sooner or later.
    You have to check what you have been eating and drinking that could possibly make swollen the neck of the lapband.
    First steps to improve are: Dieting without irritants, antacids and removing at least 1 cc from the lapband.

  5. Emily says:

    I have had the lap-band in place since August of 2004. I began having problems with severe reflux shortly after having my band placed and eventually had to have all of my fill taken out due to probable band slippage in 2006. At that time, I had an EGD that diagnosed me with gastritis and stage 2 esophagitis. I have since regained the majority of the weight I lost, and continue to have severe gastritis and reflux that wakes me up almost nightly choking on stomach contents. I take Dexilant daily and also take Carafate for my gastritis. I vomit up food almost daily as the food will sit in my stomach for hours and if I take a drink of water, it will cause me a great deal of pain and I will throw up. This is 3-4 hours after eating a small meal. I still can’t eat a great deal of food even with no fill. I had a baby in April of 2010 and shortly after, I began having a sharp, tearing like pain on my left side abdomen under my rib cage, radiation to my back and also across my port site. I first thought it was due to gas or constipation, so I increased my water intake, fiber and also began taking a stool softener. In October, the pain was unbearable. I didn’t find out what was going on at that time, because it eventually started to go away after a week or so. The pain is now back and worse then before. It is worse when I am eating or moving around. It is so bad that I have now gone to a GI MD. I am wondering it it is my band. Possibly erosion? I need this band out, but I can’t afford to pay to have it out. Any suggestions?

  6. Hello Emily,
    Something is very wrong with your lapband and with your eating habits.
    I recommend you to aspirate all the fluid and “air” that is in your lapband.
    You probably have an old lapband model that gave too many problems in the past to the patients as you are having.
    Having an upper GI will let us know the problem but either slippage or erosion those are kind of the symptoms you are having.
    Dieting with no irritants (liquid or solid) should also be a benefit to you.

  7. Emily says:

    Dr Rodriguez,
    I supposedly had all the air ands fluid aspirated from my band back in 2006 after I had an EGD that said I had stage II esophagitis and gastritis. I haven’t been able to tolerate any fluid in my band since. I will be having an abdominal CT on Monday and an EGD on Tuesday. Will those tests be sufficient to diagnose slippage or erosion? I also have a referral to a general surgeon pending, but I am unsure whether they would be willing to take out my band. I sure hope so. The pain has been getting worse this weekend and is now becoming constant vs intermittent. I’m getting a bit scared. I am definitely taking it easy with my food and drink intake and if I have to, I will put myself on a soft or full liquid diet if I have to. Although, even liquids hurt to drink, water included. I have to eat very slowly and carefully. Thank you for responding back to me. Any further input will be wonderful. Emily

  8. Hello Emily,
    Let me know about your results after they do the test.
    When they do the EGD tell them to aspirate again.
    Esophagitis is frequently find when even water promotes pain.

  9. Emily says:

    Dr Rodriguez,
    I had my CT Monday and it was negative. Had my EGD and they found that my band has slipped downward and the pouch above it is large and it is not allowing food to easily leave the pouch which is why I wake up choking on stomach contents in the middle of the night, hours after eating anything. I was NPO after midnight and they still found food in my stomach when they did the EGD. They recommended I have my band removed. They also said I still have esophagitis. I am trying to find a surgeon locally to have my band removed, but may have to pay for the surgery out of pocket. I don’t know how I’ll do that as it is around $20,000.

  10. Tammie says:

    Dr.Rodriguez, I was banded in 12-09 for the last few weeks I start getting stomach pain right in the middle of stomach between
    the belly button and rib’s that can be felt in the back also. It is a throbbing pain and sore. I recently went to my doctor and he is haveing me get an endoscopy this Tue. He also prescribe omephral. It seem’s to help somewhat. I also seem to have food restriction sometimes and sometimes not. The Doc . said he hope it’s gastritis and not erosion. What is your opinion on this? Thank-you .

  11. Hello Tammie,
    Your Doctor is right.
    Gastritis is a frequent cause of pain in the epigastric area and is associated with food restriction in lapband patients.
    Erosion is not associated with food restriction.

  12. RITA says:

    Hello Doctor.
    I had my lapband placed on Dec. 2007. Last months I experienced a lot of heartburn which got controlled with actiacids and pantecta. Yesterday after running for 35 minutes I experienced a stomach ache and inflamation, which I attributted to my lunch hours before. Had my meds. and inflammation was a lot less, but left me a pain and a reddish round Bump exactly above the port.
    Went today to my doctor, who performed an ultrasound and gave me antibiotics for 7 days, (because of the red of the bump he diagnosed infection), but I’m afraid it might be something worse, specially because after 1 day of antibiotics the bump is still the same size and it seems to have little spots or marks on it (And also the red).

  13. Hello Rita,
    Up to 30% of patients with lapband erosion show inflammation around the port area the other 70% is cause by infection.
    I am assuming that your lapband is pretty tight because of the heartburn and stomach pain.
    Antibiotics are helpful in some of the port infections, in other cases, the port has to be removed to cure the infection but your doctor has to give you a barium swallow before anything having the lapband closed to rule out lapband erosion.

  14. RITA says:

    Hello Dr. Rodriguez and thanks for such a quick response.
    This is my second day with antibiotics and the bump has decreased a little (maybe 10%) and the red is almost gone. I’m also having another consult with my Doctor again in about an hout from now. So I’m hoping and praying It’ll be a good diagnostic. Also, there is no pain at all; yesterday and the day before yesterday (when the pain started) it hurt in the area when I bended.
    Any comments? Do you think I might always need to remove the port? Also, is there a non-surgical way to remove it. I’ve gave birth to both my kids with 2 c-sections, and I don’t want to go back into the operating room again.
    Thanks

  15. Hello Rita,
    Hot and cold at the port area also helps to cure faster.
    You will need to be checked for lapband erosion as I told you anyway.
    If the infection is suppressed by the antibiotics don’t do anything but in case is not erosion and the infection persists the port in such case has to be removed.

  16. Sandy says:

    Hi Dr. Rodriguez,

    First let me say thank you so much for having this website. It is very valuable to me and I’m sure many other bariatric patients.

    I was banded 6/10 and so far have only lost 50 lbs. The slow down is simply me trying to get back on track after the holidays. However, the past several days I’ve been experiencing a pain in my left upper quadrant right under my rib cage. I have no heartburn or reflux, just this pain that comes and goes. I do take a lot of meds at night time (metformin, wellbutrin, enalapril, Cymbalta, pravastatin, vit D3, naproxen and zolpidem) – could this be an erosion or have I not had the band long enough. I notice the pain more sharply when I am hungry.

    After reading the above advice I wonder if I may benefit from simply adding an antacid when I take my meds to help protect my stomach. I do have a history (15+ yrs ago) of an NSAID induced ulcer so I always worry and would hate to find out my band has eroded.

    Any advice is greatly welcomed, thanks.

  17. Hello Sandy,
    I thank you very much for your words about y very hard work for me and my team.
    The pain you are experiencing could be related to inflammation and medications as the ones you are taking can be the probable cause.
    You need to add an antacid and an acid reducer at nights but also in the mornings al least for few days until pain goes away.
    Coffee, coke, and spicy food should be avoided.
    Naproxen is very irritant to any normal stomach and in lapband patients where restriction plays a big role it is worse to take it.
    Let me know if this info helps you.
    Have a great day.

  18. Sandy says:

    Dr. R,
    Thank you so much for your quick reply. I feel quite a bit relieved now. What would be your recommendations – Pepcid, Zantac, Prilosec??
    And both an antacid like Tums and and antacid reducer? Also are the store generics good to use as well?

  19. Hello Sandy,
    I like better Zantac when need a faster results….
    Tum or Maalox is OK and can be generics as well.
    Have a nice Sunday

  20. Kim Barnes says:

    I started with an increased heart rate about 2 weeks ago. With the increased Heart rate I experienced shortness of breath. I subsequently went to the ER, heart rate was 130. They did a cardiac work up, cleared my heart, and sent me home. Then one week later, I suddenly developed severe chest pain. I thought for sure it was a heart attack with my previous symptoms. The week preceeding my sever chest pain, I had several episodes of vomiting when I ate which I attributed it to the wrong foods. ( I was at a company meeting). II also had episodes of increased heart rate and shortness of breath, which I just tried to ignore. At any rate, I went to the ER once again with chest pain which I rated as a “10″ ( like labor pain ). Once again, they cleared any cardiac involvement.
    So after the last ER visit, I tried to eat and I could not…as soon as I swallowed a thing the sever chest pain came on. Then later that evening I was hungry, I had been pain free, and after 2-3 bites I threw up and developed severe chest pain that lasted about 30 minutes.
    So today I had an upper GI barium swallow, my band is in place and the barium went right through, no problem. Liquids go through and I do fine with them but I can tell I develop discomfort with liquids. So now they are doing an EGD tomorrow and I am concerned and worried. Wondering if it’s an erosion, hernia, or ulcer. I have had the band for 2 years.

  21. Hello Kim,
    Sound to me as acute episodes of esophagytis.

  22. Christina M says:

    Hello dr rodriguez. I was banded 10/09 I have only lost 65 lbs..I have a 10cc band and currently have 6cc I had an adjustment of .5 and could not even get my spit down. Was dry heaving from Thursday until Monday afternoon where I had fluid taken out of my band. I am at an ok restriction but feel I need just alittle bit more to reach my “sweet spot” the only complications I have had is throwing up when food gets stuck once every few days or maybe its pg’ing (I dnt know the differencce) somedays I can eat more that I think I should and some days I’m not hungry and eat once a day and have a good restriction..the pas few months I will get a sharp pain on the left side just under my rib cage when I take breath in deep or shallow..this will only last a minute or so could this be related to my band? Also I am going 2 the gym and sometimes when I do weights on my stomach and get very sore in my port area is this normal? Sorry 4 the 20 questions my doctor is very arrogant and doesn’t believe that any of HIS patients should have any probs with their band unless its our fault..

  23. Hello Christina,
    I recommend you to take specially at night Pepcid Complete and Maalox.
    Pain at the port area after Gym efforts con be frequently seen among banded patients but also in patients that for some reason are swollen at the neck of the lapband.
    Eating once a day is not recommended. To increase your metabolism you need 5 small meals a day.
    At least once a year you should have UGI to check your lapband status.

  24. Christina M says:

    Is the pepcid for heartburn? I never have any heartburn unless I’ve gone all day without eating and my stomach will burn (like an empty feeling) but have never had any issues with food coming back up at night or anything like that..I always freak out when I feel weird pains or I PB like my band has slipped or eroded..but I need 2 remind myself I don’t have any problems besides the occassional “food stuck” episodes which is normal right? I also did a barium swallow about 2.5 mnths ago because food was getting stuck (cldnt quite grasp the whole eating slow..chew chew chew rule) until now..but my band was in perfect position and doc even recommended I can get another fill which was when I was overfull for those days mentioned above and have had no problems since the slight unfill..I just always worry since I hear all these horror stories and never want to be in the same boat..what would cause swelling at the neck of the lapband? I don’t always get the pain its only when I do heavier weights..thanks look forward 2 ur response

  25. Hello Christine,
    Pepcid complete is for lowering your own acid from the stomach.
    The sharp pain you have could be related to the lapband so that is why I recommended you to take antacids.
    Pain around the port area related to heavy lifting could be caused to the muscle beneath the port, but you wrote that the sharp pain was when breathing and that your restriction comes and goes differently some days and that is swelling.

  26. Christina M says:

    Is the swelling something that is normal? Or could there be something wrong with my band

  27. IHello Christina,
    Swelling it is not normal. That is why you need the acid blockers for.
    Persistent swelling can take you to erosion of the stomach.

  28. Christina M says:

    Is it true that when on your menstral cycle the band is tightner? I have been getting stuck all weekend, up until Friday (started my period) I have been fine then bam stuck stuck stuck…if a band has slipped does it feel “stuck” and can a slippage happen overnight or does it happen over time?

  29. Hello Christina,
    Some patients had referred that they feel different restriction during the menstrual cycle but I am not sure about it.
    Lapband Slippage occurs over the time with persistent vomiting and having the gastric band with too much restriction.

  30. Christina M says:

    Hope u had a great weekend..I just hate having stuck problems..but ill chalk it up 2 my period since te tightness started the day after I started..what is the difference between pbing and throwing up..when I get stuck is when I throw it up but its whatever is above my band no acid or anything..ido love my lapband I went from a size 7 to a 23 now I’m back down to size 12..I have 30 more lbs 2 lose and I can’t go any tightner since .5 ccs was waaay 2 tight but I’ve hit a plateau I guess…it may be bc I don’t ever eat but once a day and I am going 2 the gym as well…also with slippage there would be more sypmtoms I’m sure than just having the occassional stuck problem plus with my barium swallow 2.5 mnths ago it was perfect..I just am too scared that ill have slippage with being stuck..I have no heartburn unless I’m starving and haven’t eaten all day and occassionally food getting stuck (except this wknd..all weekend stuck stuck stuck) I’m going 2 go get the pepcid complete now since I hvnt been able 2 eat 2 block my stomach acids..any other recomendations or thoughts are appriciated since I can’t talk 2 my doctor without gettin sarcasm…where are u located?

  31. Christina M says:

    I am really just freaking out because of the food getting stuck..I just want 2 make sure a slippage can’t happen over a weekend

  32. Hi Christine,
    I am located in Monterrey Mexico.
    Getting stuck with food will make an enlarged pouch and then slippage can be found.
    In your case that you have a normal UGI test done 2 1/2 months ago is OK.
    Once you start with the acid blockers you will see much more improvement but anyway, you have to eat slow and small amounts.
    Only one day meal is not good for losing weight because will go to storage as fat.

  33. Christina M says:

    Thank you! I feel better today not 1 thing got stuck and I ate breakfast (oatmeal) lunch (grilled chicken burrito without the tortilla had less thatn half) snack (peanuts) and dinner chicken again…it was hard 2 eat this much since I wasn’t hungry for brkfst and barely 4 lunch…I’m assuming my period had a lot 2 do with it…right now I fee sore in my chest which could be 4rm pbing so much or 4rm the 2 intense workouts I did yest and 2day…do u think u could email me the diet plans? I have 30 more lbs to lose to be ME again and to start modeling again…if u can my email address is christina.morales@csgrp.com…also is it bad 2 do the “liquid” diet 4 a week here n there?

  34. Hello Christina,
    You do not need to be on only liquids for a week.
    You need soft food free of irritants, eat small pieces and chew well.
    It is better to make your own meals then you know what you are eating.
    The most important part now that you are getting better is to take medications to protect the esophagus and the stomach.

  35. Christina M says:

    Thank u! Just thought id give u the update..since Monday I have been eating 3 times a day and have lost 4 lbs with going 2 the gym..also since my cycle has ended I have had no episodes of being stuck

  36. Patti says:

    Hi. I have had lapband for 4 years with minimal issues. About 5 weeks ago I acquired a nasty virus with severe nausea and throwing up for over six hours. Shortly thereafter I began experiencing shortness of breath. My dr removed about half of my fill. For a few days it seemed to improve but has since returned. I can eat just fine and have no indigestion problems. Is it possible that I irritated my stomach causing swelling or possible slippage? Should I ask for a barium swallow. Just so tired of the shortness of breath. Thank you for any advice.

  37. Hello Patti,
    You should ask for a barium swallow or at least removed all the of your fill until you have been checked properly.
    Shortness of breath can also be a symptom of cardiac failure or pulmonary problems so it is imperative to take the symptom with care.

  38. Christine says:

    I had the lapband placed 7/09. I lost 60 the 1st year, but have regained 10-15 since I switched to working nights in November and no energy in the day to go to the gym. A couple months ago I started to vomit here and there. If I am constipated, near my period I am very tight and sometimes I just eat 1 small well chewed bite and it just doesn’t stay down. I basically ignored the symptoms and figured I had learned to deal with it until 2 wks ago. I was at work and developed midsternal chest pressure. I figured it was stress related and lack of sleep. It has been off and on until I said something @ wk and they did a 12 lead EKG. All looked ok except notched P waves, but overall sinus rhythm. The pain continued off and on & I realized it could be my band. I went to the surgeon who placed it and told him my symptoms. I asked to be completed deflated, I had 4 1/2 cc in a 10cc port. He said he needed to leave 1 1/2 cc for “atomspheric pressure”? Do you agree??

    Since the fluid removal, the chest pressure has eased up, not completely gone, but now feels like my stomach is on fire. I am afraid to eat. I drink water, herbal tea with no problems and have had some broth. Anything like egg white protein drinks burns my stomach or cold drinks. When I asked for barium swallow the surgeon said, lets wait and see, I said no, I want it done. I am scheduled for a barium swallow eval this Wed. (tommorow) Even though I haven’t eaten much, I have woken up a couple times coughing. (new symptom) Last night I slept with 2 pillows proping me up.

    Also to note I have felt pain at my port site since day 1. I was told it would go away, but the lightest pressure/touch and it’s sore. No abscess or redness visible in this area.

    My question to you is, since you are located in Mexico, do you accept patients from the states and will you remove the band and port? If so, how long of a recovery period to get back to full time? Providing there are no post op complications (I’m a RN and work as a floor nurse in a hospital).

    I may have to take a medical leave to take care of this. If so, I would rather wait until January if I can (if my health is ok)

    Regardless of what the results are tommorow, I want my band removed. Unfortunately, I don’t have the confidence in my surgeon nor do I like his bed side manner. Unfortunately the other MD in the area that does this type of surgery will not touch another surgeons work.

    I am frustrated. I have lost my patients and my hair! Something that they didn’t warn me about ahead of time. I have taken vitamins/supplements and orginally thought it was due to the anesthesia and stress.

    I appreciate your input.

  39. Hello Christine,
    First of all, thank you for sharing your concerns.
    What I would do: I would removed all the fluid from your lapband then do a barium swallow and also will look for Helicobacter Pylori.
    Your are very symptomatic even with little amount of fluid and also can be caused by swollen inflammatory reaction inside the pouch and the esophagus.
    You should be on acid blockers and antacids in a regular basis until you find out what causes of your problems.
    I need 3 nights here for de-banding and is as simple as placing the lapband.
    Let me know if I was of some help.

  40. Christine says:

    I appreciate your input. I had the small sip barium swallow and was told the band has not slipped, but he is concerned about erosion. He referred me to a GI doctor, but 1st available apt is 8/1. I suppose after that visit an endoscopy will be ordered. I am not feeling well at all. I bought some Prilosec, over the counter and Malox.

    I appreciate your input and will keep you posted.
    Sincerely,
    Christine

  41. Jan B says:

    Hello,
    I have a few questions. I was lapbanded in Oct 2009 and only have lost 20 lbs. My band holds 10cc and I am now at 8.5cc (.5 was added today). I told my surgeon that only two times since the procedure have I felt “absolutely full and can not eat another bite” after ingesting a small amount of food. I also said that the major way that I can tell that I have eaten too much is that the port hurts (which is what his nurse told me). He said that was not normal. I can eat all foods, inlcuding breads, but I certainly do not eat the volume I used too. I have a bit of heartburn if I am hungary and can feel the food “pop” thru the port when I am eating.
    The surgeon is wondering if there is some erosion as I very rarely feel “full”. I just want to be in the “zone” and have the lapband work as a tool to lose weight. Your opinion is appreciated. Thank you! Jan

  42. Hello Jan,
    Almost 2 years with your Lapband and you only have lost 20 pounds. I don’t know how far you are for reaching your weight goal.
    You are the one that knows what you are eating so you have to write down for a week everything and then checked for easy calories to quit them.
    If the port hurts that means there is some inflammatory reaction and is not good at all.
    You fills should be done with barium to have the lapband checked and to have the proper adjustment.
    Having reflux means also inflammatory reaction or having the Lapband very tight.
    You should have Maalox and prilosec on regular basis.

  43. Diane says:

    Hello Dr.
    We have just gone through an awful experience last night with a lap band gone bad and I wanted to ask your advise on what actually happened. My friend had a lap band put in 2 years ago and was having problems over the past 3 mos of vomiting bile. For a couple days she was having severe pains and presented to the emergency room. They didn’t keep her and was sent home. Yesterday the pain was unbearable so she went to hospital at lap band dr suggestion. With xrays we found that there was a black area around the upper stomach as well as a white area. Explanation given was that as she vomited the stomach had come up through the band and the band acted like a tourniquet and killed that section of the stomach.

    That being said the doctor then had to figure out a solution to the problem. He ended up pulling the dead section into the inside of the stomach and suturing the outside. The plan is that stomach enzymes will destroy and remove the dead areas and she will be able to recover.

    1. Have you ever heard of this happening?
    2. Have you ever heard of this type of solution?
    3. Can you see any potential complications with this as I am thinking a large chunk could erode and block the lower sphincter?
    4. What should we be looking for as far as complication symptoms post op?
    5. Any idea what the white area might have been as Dr said that he had never seen a white area like that before. Also note that area was very inflamed that is why the dr did not cut the dead area off and suture on outside of stomach. He said there was not enough good tissue to work with.

  44. Hello Diane,
    Did your doctor say the word slippage?
    When there is a slippage the lapband acted like a tourniquet or as a “hernial ring” and part of the lower stomach passes though the lapband and gets trapped in there.
    What I do is: I open the lapband if feasible and then re-locate the lapband or, more often, I de-band the patient and wait for 6 months to place a new lapband.
    I really don’t know if what the doctor did will work (some kind of plication). I also don’t know the size of the slippage either.
    I would like to know how your friend does.

  45. Diane Walker says:

    Hi Dr-
    Yes the doctor did use the word slippage. Right now due to the weakened condition of her stomach they are planning on putting her on TPN for 4-8 weeks and she must be NPO during that whole time. The surprise to us is that the strangulation of the stomach happened so quickly-like 16 hours.

    The area must have been quite large as he has sutured 2/3 of the stomach. You say you deband the patient-has the area ever turned black on you?-We saw the pictures and there was definitely a whole black and inflamed area where it had slipped.

    He is in the watch and see mode has he has never seen anything like this happen in 4000 lap band surgeries.

  46. Hello Diane,
    I’ve known of many doctors in the US that with minor problems they de-banded a patient.
    I would have done a de-banding if I saw any necrotic area over the gastric pouch or any sign of strangulation to release the blood flow to the compromised stomach.
    It is very easy also for me to say what the doctor should have done after decisions were taken during surgery.
    I’ve never had the need to place a lapbanded patient in TPN.
    I just can think in two doctors in the States that could have that amount of surgeries, both had gained experience in their own country before doing lapband surgeries in the US.

  47. Annie says:

    I have the lapband and I am having trouble with I just go it tighten, when I eat I can eat more that I could before I got it tighten and then I am having hunger pain about 1 hour after I eat. I am aspirating at night when I lay down. What do you think I need to do about this, and does this sound like slippage or eroison. Thanks

  48. Hello Annie,
    I think you need a Barium swallow.
    Also, you need to check what you are eating or drinking because you have gastric reflux and need to take antacids.
    What kind of lapband do you have and how tight is it?
    Let me know.

  49. Nicole says:

    Hello, I had my Lapband in 2008. I have been to a few docs. and no one seems to know whats wrong. I have pain from my belly button to the bottom of my ribcage. I’ve had ultrasound and CT Scan done too. I ended up in the ER for the pain. They finally gave me some pain pills which helps but doesn’t totally get rid of it. Also, I feel bloated and I’m going to the bathroom but not like I have. Sometimes I get little sharp jabs. I’m not sure what my next step is. If you have any suggestions I would really appreciate it. Thanks!!!!

  50. Christy says:

    hello Dr.
    I have been having alot of pain, anytime I drink anything acidic I about die, the pain goes all the way up into my shoulder!! I am not an alcohol drinker but I do love my juices, could that cause an erosion? The side where my port is, hurts really bad in my back!! I can take Prilosec OTC and it relieves the pain!! I thought something might be wrong with my liver but it’s more in the center of my stomach. My band has a leak and will no longer hold liquid and I am having all of these problems!! Do you think it could be erosion? I of course have gained all of my weight back but I have been working out, eating less and working really hard to get back on track, I know I should have a flouro but I don’t have insurance so it’s hard for me to do alot of testing, I don’t want to go medically broke, if you know what I mean!! Would a flouro tell me if I have erosion? I have a VERY old lapband :(

    Thanks a bunch,
    Christy

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