Weight Regain After LABG: Ponder to Intra-gastric Migration of Adjustable Gastric Band

Abstract

Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive bariatric procedure. However troublesome complications can arise later with this procedure including band slippage and erosion. Intra-gastric erosion is a rare but major bothersome late complication after LAGB and requires band removal. A 35-year-old lady with BMI of 45.03 and hypertension as co-morbidity opted for LAGB. The patient started losing significant weight, however patient noticed sero-purulent discharge from epigastric port site after three months. Investigations were not suggestive of any leak, but persistent discharge led to wound exploration and infected band tubing was removed. The patient again noticed discharge from the port site after 20 months of primary surgery along with weight regain. Oral gastrograffin study was performed, which showed no evidence of contrast leak, however band seemed lower in position. Upper gastrointestinal (UGI) endoscopy showed a part of circumference of the band in the gastric cavity confirming intra-gastric migration and not retrieved due to adhesions with gastric wall. The band was removed by laparoscopic converted to open procedure due to dense adhesions. The patient recovered well. Migration of the band through the stomach wall is an uncommon late complication that may remain asymptomatic but must be thought in presence of weight regain or port-related complications. UGI endoscopy is diagnostic and therapeutic in most cases, rest of the cases require laparoscopy or laparotomy for band removal, depending upon surgeon or endoscopist expertise.