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.
I had my Lapband surgery 2/7/08. I have lost 25 lbs to date. I have approx 9.5 cc’s in and my physician will not fill it anymore because anymore causes reflux. I started having lower abdominal pain that radiates around by back. I have asked to have revision surgery; possibly a sleeve due to the lack of weight loss. I was told that in order for my Insurance Company to consider it, I would need to have something wrong with my band. I have an Upper GI and abdominal x-rays scheduled.
Should I also request an endoscope?
Hello Nyla,
I don’t know what is your weight loss goal but 25 lbs is not that much of a weight loss with a lapband.
You can also have an endoscopy to full fill the insurance requirements for having a revision surgery.
The Lapband works very well for changing bad habits progressively by eating small amounts of food, taking your time to digest your food and helping you to choose the right food for you.
9.5 cc’s inside the lapband looks a little too much for me because you have to balance the restriction that gives you with some exercise.
Hi Dr. Rodriguez,
I am an RN. I have had my realize band for almost 3 yrs. It holds 9cc of fluid. I had 8.5 cc in there. Last Sat night, I ate a hot dog and raw vegetables. About 2 hrs later, I started having sharp pain under my left breast/rib cage, chest pressure that felt like air trapping, and dry heaving. My surgeon met me at his office and removed all of my fluid (there was 8.5 cc in there and about 1cc of air). Since then, I can only tolerate liquids and soft food–yogurt, purees, etc. I am still having intermittent sharp pain in the same rib/breast area, still having air trapping although I am able to eventually expel it. I am scheduled for an UGI in 4 weeks. I also admit that I am a coffee drinker and use liquid ibuprophen on a routine (although not daily) basis. I am concerned about erosion, infection, or slippage. Do you think I should start taking antacids and/or acid reducing medication? And if so, which ones? Thank you for hosting this forum!
Hello Patty,
Your welcome to ask your concerns with me.
I recommend you to start taking antacids and acid blockers and to quit for while ibuprofen, coffee and spicy food.
It is most likely that you have esophagitis because of the pain you are describing. Keep on soft food and liquids for as long as you can and you should be feeling better in 3-4 days.
hello Dr.Rodriquez. I had LB surgery 3 years ago and since then I managed to drop 70 lbs and have since regained my weight. I notice a shoulder pain almost gaslike lately. Eating some protein is painful going down despite how slow I chew. I have to admit my eating habits have not been stellar but i am making healthier choices still my weightloss has ceased. Can you please tell me what could be the cause of this shoulder pain and what I can do with my diet? I have cut out a lot of carbs also. I may also mention that prior to my surgery I did not eat a lot of sugar, however since surgery all i crave are sweets…
Hello Regina,
Shoulder pain can be cause by “irritation” around the lapband or esophagus so I recommend you to have a barium swallow.
It is very difficult lo lose weight when eating sugars unless you increase your daily activity and burn out the excess of calories.
It is better no to have too much of restriction and eat healthy food than eating liquid calories.
Dr., I just had the Lapband procedure thru “the LB center” four days ago in SoCal. The surgeon said he fixed my small hiatal hernia during the procedure. I was taking one Omeziprole ea AM prior to this. Shall I continue taking it? I want to do everything possible to avoid erosion of my soft tissue so what are the best ways to help prevention of this, and is it highly likely to occur at some point in time regardless of the preventive measures taken? Thank you kindly!
Hello Suze,
You can still taking your omeprazole after surgery and also acid buffers as well after having the lapband. I do recommend them even if you don’t feel like needing to take them. Avoiding hot, spicy, alcohol and all what your doctor told you to avoid will help in having your lapband for long time. Congratulations.
Dr., I have my band surgery back in 08/2009, at the begining I lost a total of 50 pounds, the surgery happened in Dom. Rep., and I am now living at the USA, I been going to a lap band doctor in my area for the port fills, but unfortunatelly for past 6 months I starte having pain in my port, along with gain of weight about 30 pounds, today I just got a new lap band doctor scheduled me for a fluoro fill (I just got an endoscopy done few weeks ago and revealed that the band is sitting properly), but today under fluro my new doctor said he was not going to fill it as I need surgery to replace the port as same has flipped, he wants the records showing the specifications of my port (which is a Slimmer/Smaller made by Silimed 11.4mm as given by my overseas surgeon), the problem is that the new doctor is under the impression that surgeon whom performed the surgery was the doctor in the USA whom refered me to him, I know he would not touch me if he find out I got surgery overseas, so I let him believed the surgery was performed in USA, but know that he wants the specification of the port to order the exact one, I dont know what to do as I dont want to tell him that I lied and probably have him rejecting me (he is cover under my current insurance). I am very upset as I dont know what to do, can you please give me advise.
Hello Belkis,
I don’t know what kind of a lapband you have but ports of Allergan or of J & J ,lapbands and realize band, when they flipped the treatment is just re-locate the same port unless there is an infection which the port needs to be removed while infection is there.
Oh my gosh imso scared I have had lapband since 06 have been throwing up for sometime I’m on omeprazole because I have a bad taste innmy mouth all the time do you think that isbecause. Of vomitting or erosion ive keeped about fiftypounds of but put about 30 back on I’m scared
Hello Lisa,
You need a barium swallow for lapband evaluation and detecting possible complications. Some of the lapband slippages could give you halitosis.
Hi Dr Rodriguez,
I just had my band placed on 4/9/12. I started feeling better at day 4 and 5 and even better on day 6. However, today I’m having a lot of pain in the middle/right side of my back and a lot of what feels like pressure on the left side (under my ribs). It actually hurts to lay flat. When I do and I try to take a deep breath it is VERY painful and almost feels like something is stopping me from taking in that breath. I did have a little little bit of tuna fish today (soft food as my diet says I can). It hurts to stand up straight too. I’m having a hard time drinking fluids because it feels like I’m adding to the pressure. I see my doctor on Tuesday but was wondering if this was normal or what it could possibly be.
Thanks so much!
I need to add to my above post. I also had my gall bladder removed that day. I’m also having this thing that feels like a hiccup but gets stuck below my diaphragm. It happened a lot the first few days then stopped but started back up today. It creates a lot of pressure when it happens.
Hello Jennie,
You need to quit taking vitamins or protein shakes if you are doing so.
Also need to take Maalox and Pepcid and no irritants.
You also need to call your doctor to be evaluated to ruled out that your symptoms are related to gallbladder surgery.
Thanks for responding so quickly Dr Rodriguez! I actually had diarrhea for a while. Anytime I would drink something it would go right thru me. I haven’t had an shakes for days but I was taking vitamins so I will stop that. My doctor had me drink Propel because of the diarrhea and start taking my pain meds again to stop it. I will see my doctor tomorrow so hopefully I’ll get some answers then. Thanks so much!
Hi Jenny,
Your questions are welcome any time.
Hello Doctor.
I have had a lap band for 13 months now and this last week I have been experiencing pain under my left rib for almost a week now! What does this mean?
Hello Amanda,
I like to take seriously when is pain at the port area or under the left ribs.
I usually take some of the fluid out and at the same time evaluate the lapband status.
You can take antacids while you have your lapband evaluated.