Laparoscopic adjustable gastric band tubing erosion into large bowel

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A 50‐year‐old female presented with a 3‐day history of fevers and myalgia on a background of 2 weeks abdominal pain that progressed to severe epigastric pain and vomiting postprandially. Twelve years earlier, she had undergone laparoscopic adjustable gastric band (LAGB) insertion that had been complicated by slippage and adjustment 12 weeks after insertion. At the adjustment, an extra length of port tubing was added to the original tubing. The patient had no history of infection of the band including the port tubing and port. Although 2 weeks prior to presentation, her band had been deflated because of a leak. On examination, she had a fever to 38°C and a soft abdomen with epigastric tenderness. A chest X‐ray revealed an appropriately positioned gastric band. A computed tomography scan revealed oral contrast passing through to the duodenum but that the gastric band tubing appeared to traverse the ascending colon – as shown in Figure 1. At laparoscopy, there were dense adhesions along the length of the band tubing that were released and the original length of tubing was found to enter the ascending colon. The operation was converted to laparotomy with the LAGB being removed and the colon defect being repaired. The patient made an unremarkable recovery and was discharged home 4 days post surgery.
LAGB surgery has been performed in Australia since 1994 and has been the most common form of bariatric surgery in Australia. Recently, there has been a trend away from LAGB. In an Australian study by Bardsley and Hopkins,1 greater than 13% of patients undergoing LAGB surgery required re‐operation because of complications. The more common reasons for re‐operation being band slippage, tubing or balloon leakage, failure of weight loss, band erosion and port revision.
LAGB port tubing is considered to be inert and there are very few cases of complications arising from erosion of the tubing. The most likely mechanism leading to tubing erosion is bacterial colonization of the tubing as previously proposed by Sneijder et al.2 Of the few cases of tubing erosion reported in the literature, all were associated with port infection.
Although the number of LAGBs being inserted in Australia is decreasing, there is still a significant number of patients with bands in situ that will continue to develop complications in the future and it is important to keep this in mind when these patients present in the acute setting. This case demonstrates that although complications from LAGB tubing erosion are extremely rare, they are possible in the setting of tubing infection, and should be kept in mind.

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