1036 Colonic Erosion of a Laparoscopically Inserted Adjustable Gastric Band

Abstract

Abstract The popularity of laparoscopic adjustable gastric band surgery has declined over the past decade. This is partly due to concerns about a high rate of long-term complications, including band erosions occurring in over 1% of cases. Erosion into the colon is exceedingly rare, with only three reports in the literature. Our images/video illustrate the case of a 51-year-old female patient presenting in February 2022 with abdominal pain and two chronically discharging sinuses around her port site. She had a gastric band initially fitted in 2010, which was revised in 2018. The port was re-sited in 2021 following port-migration and flipping. On this presentation, a CT scan revealed 16cm of tubing within the lumen of the descending colon. Our procedure began with diagnostic laparoscopy, showing the gastric band tubing entering an inflammatory phlegmon in the left flank involving omentum and descending colon attached to the abdominal wall beneath the port site. The tubing was cut near to the gastric band. The gastric band was freed, divided, and removed. The previous port site incision was extended around the external opening of the fistula, which was excised. The port and tubing were easily removed, though partly covered in faeces. A decision was made, based upon prior discussion with the patient, to leave the colocutaneous fistula in-tact. This avoided the risk of colonic resection and anastomosis in freeing the bowel. Stapling across the phlegmon and tract risked diverting colonic contents into another potential tract headed towards the stomach. Postoperative recovery was uneventful.