A rare sequela after a case of early bariatric surgery tourism

Abstract

Laparoscopic adjustable gastric banding (LAGB) is awell-established, safe procedure that may be an effectivetreatment of morbid obesity, although many surgeons are nolonger performing this procedure because of its comparativeinadequate weight loss [1]. LAGB is associated with fewercomplications and a lower mortality rate compared withsleeve gastrectomy or gastric bypass [2,3]. However,because of the presence of a foreign body, unique compli-cations may arise involving any of the components of thedevice. Complications resulting from the access port orconnecting tube, such as port infection, are largely consid-ered to be minor complications and range from 4.3% to24% [4,5].We present a rare case of jejunal perforation and intra-luminal migration caused by the tip of the catheter left free-floating in the peritoneal cavity after surgery to remove aninfected port. The surgeon who removed the port wasunfamiliar with the patient’s non FDA-approved gastricband, which had been originally placed abroad, causing themajor complications of this case. This rare LAGB compli-cation might be considered a consequence of one of theearliest cases of bariatric tourism so far described.Case presentationA 43-year-old female presented to the emergency depart-ment with a 2-year history of abdominal pain thathad increased in severity 2 weeks before presentation.The patient’s surgical history was significant for LAGBplacement in France 12 years earlier. She developed asevere infection at the port site 1 year before presentation tous, requiring port removal. The surgeon who removed theport, based on the patient’s report, did not plan to follow-upwith port replacement or band removal as “he did not feelcomfortable enough to handle a device [MIDBAND,Medical Innovation Development, Dardilly, France] forwhich he had received no specific training and one thathad not been approved for use in the United States.”ManagementThe patient underwent a computerized tomographic scanof the abdomen and pelvis that showed erosion of thecatheter into the small bowel without evidence of free air orintestinal leak (Fig. 1). Upper gastrointestinal endoscopy