Complication Of Laparoscopic Adjustable Gastric Banding Research Articles

S3131 An Unusual Case of Postprandial Diarrhea: Gastrocolic Fistula from Gastric Band Erosion

Introduction: Bariatric surgery is increasingly performed nowadays. Gastroenterologists may encounter patients with its complications. Known complication of laparoscopic adjustable gastric banding (LAGB) include reflux, band slippage, erosion, pouch enlargement, and port breakage. We report a case with an unusual complication of LAGB. Case Description/Methods: A 45-year-old male with LAGB and atrial fibrillation presented with chronic diarrhea. Symptoms onset was 3 years ago after his partial small bowel resection when he presented with peritonitis. The patient reported loose stool within 15 minutes after each meal, abdominal pain, and 13-lbs weight loss. Physical exam was unremarkable. Laboratory data were within normal limits except mild anemia (Hgb of 12.9 g/dL) and mild renal impairment (Cr of 1.55 mg/dL). Upper GI study with small bowel follow through showed two separate channels arising from the proximal stomach with one connecting to the mid-transverse colon, suggesting a gastrocolic fistula (GCF) (figure 1A). CT scan of chest/abdomen/pelvis that was performed prior to barium studies was reviewed and demonstrated gastric erosion of the LAGB, with tethering of gastric cardia to the transverse colon with prolapse of the tubing into the distal transverse colon (figure 1B). Subsequent upper endoscopy showed an eroded gastric band in the gastric cardia and appeared to be extending through the gastric wall (figure 1C). Colonoscopy noted gastric band was entering transverse colon and extended distally (figure 1D). Surgical specimen of previous small bowel resection was reviewed and didn't show small bowel ischemia nor small bowel Crohn’s disease. The patient is currently evaluated by a bariatric surgeon for the definite treatment. Discussion: GCF is an uncommon manifestation of certain malignancies, pancreatitis, Crohn’s disease, peptic ulcer disease, and few cases related to other bariatric surgeries, usually with sleeve gastrectomy. LAGB related erosions of stomach, colon, and small bowel have been reported. To best of our knowledge, there are only 3 other cases of GCF related to LAGB. We report a rare complication of LAGB. Mechanism of GCF from LAGB is not fully understood, and is likely related to erosion of gastric wall from band pressure or foreign body reaction. Symptoms includes abdominal pain, weight loss, diarrhea, and sepsis. Diagnosis is made with upper GI series, contrast enhanced CT and endoscopic visualization. Surgery is the mainstay of treatment with removal of band and closure of fistula.Figure 1.: Endoscopic image of gastric ulcer in first case (A). Microscopic image H&E stained 400x of lymphoepithelial lesion with surrounding lymphocyte mucosal invasion (B). Endoscopic image of polypoid lesion in second case (C). Microscopic image H&E stained 200x of diffuse lymphocyte invasion into the lamina propria and muscularis mucosa (D).

S1896 Not Your Average Diverticulum: A Unique Case of a Massive Esophageal Diverticulum After Laparoscopic Gastric Banding

INTRODUCTION: Food impactions are a common gastrointestinal emergency, occasionally requiring urgent retrieval of an obstructing food bolus from the esophagus. This is a case of food impaction in a large esophageal diverticulum that developed as a long-term complication of laparoscopic adjustable gastric banding (LAGB) for obesity. CASE DESCRIPTION/METHODS: A 76-year-old woman presented to the emergency room complaining of dysphagia and neck discomfort after eating turkey. Her medical history includes gastroesophageal reflux disease, heart failure and morbid obesity, treated with LAGB several years prior and subsequently removed four years prior to the current presentation. She had previous food impactions that resolved spontaneously without endoscopic intervention. On presentation she was anxious, uncomfortable-appearing, mildly hypoxic, but able to handle her oral secretions. Computed tomography (CT) imaging of the chest showed a dilated esophagus with a right lateral diverticulum containing an impacted 10 cm × 7.4 cm food bolus and lung opacities concerning for aspiration pneumonia. The patient underwent an endoscopy with partial removal of the massive food bolus that was lodged in the diverticulum. The GIF-190 and GIF- XP scopes could not be advanced into the true esophageal lumen due to compression of the lumen by the huge diverticulum. Three days later, an endoscopy was performed with removal of the remnant bolus from the esophageal diverticulum, and placement of an orogastric tube over a guidewire. The mucosa of the upper esophagus was noted to be dusky-appearing, likely from pressure necrosis. The patient had a month-long ICU stay for chronic hypoxic respiratory failure due to aspiration pneumonia and inability to wean off mechanical ventilation. Surgical intervention to repair the esophageal diverticulum was discussed, but was deferred given the patients age, morbid obesity and medical comorbidities. Ultimately a tracheostomy was placed for long-term mechanical ventilation and a gastrostomy tube was placed under fluoroscopic guidance for enteral nutrition. The patient was discharged to a long-term care facility. DISCUSSION: This is a case of a large esophageal diverticulum that developed as a late complication of LAGB. Patients with prior LAGB presenting with dysphagia require imaging and possibly manometric evaluation to assess for pseudoachalasia. This directs need for endoscopic or surgical intervention to avoid progression to large esophageal diverticular disease and subsequent complications.Figure 1.: CT abdomen and pelvis with out contrast demonstrating an axial view of a large esophageal diverticulum with 10 cm food bolus.Figure 2.: CT abdomen and pelvis with out contrast demonstrating a coronal view of a large esophageal diverticulum and right sided aspiration pneumonia.Figure 3.: The upper third of the esophagus with dusky appearing mucosa in the large diverticulum seen during second endoscopy.

Technical Details and Result of a Minimally Invasive Management of Gastric Band Erosions: a Series of 47 Patients.

Laparoscopic adjustable gastric banding (LAGB) is proven to be a safe and effective treatment option for obesity in the long term. However, in recent decades, LAGB prevalence progressively decreased worldwide principally due to the incidence and the management of the complications. Understanding the optimal management of the complications becomes therefore of primary importance. The aim of this study is to describe a personal technical, laparoscopic solution of band erosion and to analyze outcomes in 47 patients. From October 1995 to January 2019, 3697 LAGB were performed at our institution. Since November 2011, an original laparoscopic gastric banding removal technique was introduced. All the bands placed in these patients were Lap-Band AP System (Allergan, Irvin, CA). The data of the patients who underwent gastric band removal because of band erosion were retrieved from a prospectively collected institutional database, and used for the present retrospective evaluation. Ninety-four patients (2.5% of the entire casuistic) with eroded band were diagnosed and treated at our institution. Forty-seven patients were treated with the laparoscopic gastric banding removal technique introduced in November 2011. All the operations have been performed laparoscopically with no conversion or intraoperative complications. There were neither major complications nor peri-operative (30days) mortality. Proper preoperative management and a standardized minimally invasive technique could help to cope with erosion, the most frightening complication of LAGB. Understanding the optimal management of complications and safe reoperation techniques can contribute to a rational use of the LAGB, reversing the current declining tendency.

Recurrent Pneumonia: The Answer Is in the Esophagus

Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. Stomach and esophagus dilation are rare; both are occasional complications of LAGB. Bronchoaspiration can occur as a late complication of gastric band placement, a serious complication that can be prevented by immediate deflation of the gastric band. We describe a case of a 44 year-old male patient who was treated for recurrent respiratory infections for several months and was subsequently found to have megaesophagus on further evaluation. A 44 year-old male with history of laparoscopic adjustable gastric band placement 4 years prior, presented to pulmonary clinic as a consultation for frequent respiratory infections requiring at least 7 courses of antibiotics over few months. He complained of persistent productive cough, exertional dyspnea and chest pain. Rest of review of systems was negative. His physical examination was normal. CT chest showed multiple tiny lung nodules representing a manifestation of recurrent and chronic aspiration and substantially dilated esophagus with fluid in the lumen (image 1). The patient was referred to GI clinic and after thorough evaluation, EGD was done that showed fluid in the lower third of the esophagus, dilated lumen of the lower third of the esophagus with no stenosis or stricture in the entire esophagus. It also showed a 4 cm gastric pouch in the stomach with fluid content proximal to the constriction from the lap band (EGD views are shown in images 2 and 3). Removal of the gastric band was performed with subsequent resolution of his symptoms. LAGB is approved for treatment of morbid obesity with successful outcomes by many bariatric surgeons worldwide. It is preferred due to ease of implementation and low rate of perioperative mortality. Megaesophagus with dysphagia can occur as a long term sequelae of LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires band removal in most cases. Clinicians should be made aware of this rare entity when they encounter patients with frequent aspiration who had bariatric procedures. Inquiry about detailed relevant surgical history is also recommended.Figure 1Figure 2Figure 3

Management of laparoscopic adjustable gastric band erosion.

Laparoscopic adjustable gastric banding (LAGB) was a popular procedure in the USA and Europe in the past decade. However, its use has currently declined. Band erosion (BE) is a rare complication after LAGB with a reported incidence rate of 1.46%. Controversies exist regarding the management, approach and timing for the band removal. The aim of this study is to describe the rate, clinical presentation and perioperative outcomes of BEs at our institution and provide overall recommendations regarding the diagnosis and management of BE. This study is a single-center, retrospective review of a prospectively maintained database. Data were collected from all consecutive patients who underwent a LAGB and band revisional surgeries at the University of Illinois Hospital and Health Sciences System from December 2008 to September 2015. We identified patients who underwent gastric band removal due to a BE and analyzed their outcomes. A total of 576 LAGBs were performed at our institution. Nine patients underwent surgery for BE at our hospital. The average time between the primary surgery and the removal of the band was 68.5 (42.9) months. Abdominal pain, nausea and/or vomiting were the most frequently mentioned symptoms. In all patients, a minimally invasive approach was used to remove the band. The mean length of hospitalization was 2.6 (1.1) days. The only complication was a pneumonia (n=1). BE is one of the most severe complications of LAGB. The minimally invasive approach provided us with the opportunity to repair the fistula, and it was associated with a prompt recovery with very little morbidity. In general, it is recommended that the band be removed at the time of the diagnosis of the BE. Endoscopic band removal can be utilized with patients who have a more advanced BE and migration into the gastric lumen.

Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band.

Obesity is a major problem with the number of obese patients presenting to cardiac surgery is ever increasing. Laparoscopic Adjustable Gastric Banding (LAGB) is one modality commonly used to mechanically reduce food intake and also promotes early satiety. Late complications of the device may occur in up to 20% of cases; increasing up to 30% in pregnancy. We report the first case of a late complication of LAGB after cardiopulmonary bypass.

Life-threatening late complication after laparoscopic adjustable gastric banding: two cases of gastric necrosis

/10.10 16 A mmo ence: Univ oul, 1 1997@ The prevalence of obesity in Korea increased from 26.9% in 1998 to 32.0% in 2011, according to data from the Korean National Health and Nutrition Examination Surveys [1]. Laparoscopic adjustable gastric banding (LAGB) is a restrictive operation frequently performed on obese patients, although laparoscopic sleeve gastrectomy has become an increasingly popular alternative [2]. Currently, the only effective treatment for obesity is bariatric surgery, given that neither lifestyle modifications nor pharmacologic interventions result in sustained weight loss [3]. In 1991, Belachew et al. introduced LAGB, and it was adopted quickly worldwide [4]. Although its use is now declining and in some countries it is no longer performed, LAGB remains a relatively common procedure in Korea [2,5] because of its minimal invasiveness, ease, and reversibility. However, complications of LAGB are well documented and include migration, erosion, prolapse, infection, pouch dilation, and gastric perforation [6,7]. Here, we report 2 cases of gastric necrosis, a rare but serious complication of LAGB.

Outcomes of revision laparoscopic gastric banding: a retrospective study

Obesity is a health problem approaching pandemic proportions. Laparoscopic adjustable gastric banding (LAGB) is the bariatric procedure of choice in Australia for effective surgical treatment of severe obesity. Complications of LAGB lead to a high proportion of patients requiring revision surgery. However, literature regarding outcomes and failure rates of revision bariatric surgery is scarce, such that the choice of procedure at reoperation remains controversial. This paper aims to present outcomes of revision laparoscopic gastric banding. One hundred eighty-three consecutive revision LAGB procedures were performed in 163 patients between March 1998 and July 2009. Patients were followed up for a median period of 36 months. Weight change in terms of body mass index (BMI) and percentage excess weight loss (%EWL), morbidity and patient tolerance were examined. The average reduction in BMI from the primary LAGB procedure was 8.45 kg/m(2) , equivalent to a %EWL of 50.55. BMI of patients who underwent revision LAGB appears to remain stable, with mean change of +0.25 kg/m(2) (%EWL 45.76, P = 0.5) at 3 years and -1.59 (%EWL 51.52, P = 0.12) at 5 years. The overall complication rate of revision LAGB was 13.7%, most commonly recurrent gastric pouch dilatation. Revision LAGB is reasonably well tolerated by most patients. Preliminary outcome data indicate that revision gastric banding does not result in further weight loss in patients who have lost weight from primary banding, but does maintain the weight loss achieved.

Laparoscopic Adjustable Gastric Banding: What Radiologists Need to Know

Laparoscopic adjustable gastric banding (LAGB) is performed with increasing frequency for the management of morbid obesity. Although LAGB is less invasive than other bariatric surgical procedures, it is associated with various complications that may lead to nonspecific abdominal symptoms several months or years after the procedure. Because complications of LAGB may be encountered incidentally at imaging for other indications, all radiologists should be familiar with the appearances of correctly positioned and malpositioned gastric bands, normal and abnormal appearances of the postprocedural pouch and stomach, and imaging features suggestive or indicative of early or delayed complications of LAGB. Familiarity with the techniques and systems currently approved by the Food and Drug Administration for use in this procedure may help radiologists detect postoperative complications and guide their management. Both commercially available systems include a silicone gastric band with an inflatable inner surface, a reservoir port, and a tube that connects the port to the gastric band. All these components of LAGB systems should be visible at radiologic imaging; however, older models of gastric bands may not be radiopaque and therefore may not be depicted on images. The most common complications of LAGB are gastric band slippage and associated pouch dilatation, intragastric erosion of the band, gastric perforation, and abscess formation. Complications that occur with less frequency include tube migration, tube disconnection, port-site infection, and small bowel obstruction.

Gastric band migration following laparoscopic adjustable gastric banding (LAGB): two cases of endoscopic management using a gastric band cutter

Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently used minimally invasive and reversible procedures for the treatment of morbid obesity. Migration of the gastric band into the gastric lumen is a rare late complication of LAGB. Previous attempts at endoscopic removal of migrated bands have included the use of endoscopic scissors, laser ablation and argon plasma coagulation (APC). We report two cases of successful endoscopic management of gastric band migration using a gastric band cutter.

Conversion of failed gastric banding into four different bariatric procedures

BackgroundThe most common bariatric operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. The optimal conversion technique is unknown. Our objective was to report our experience in the conversions of failed laparoscopic gastric banding procedures to 4 different bariatric procedures at a university hospital. MethodsFrom March 2006 to December 2010, 630 bariatric operations were performed. Of these patients, 45 underwent conversion of failed LAGB (n = 38) and nonadjustable gastric banding (n = 7). Using a prospectively collected database, we analyzed these procedures. ResultsThe 45 patients underwent laparoscopic conversion of failed LAGB (n = 38) and nonadjustable gastric banding (n = 7) to 4 different procedures. Of the 45 patients, 18 underwent conversion to laparoscopic sleeve gastrectomy, 18 to laparoscopic Roux-en-Y gastric bypass, 7 to laparoscopic biliopancreatic diversion with duodenal switch, and 2 to laparoscopic biliopancreatic diversion. All conversions but 1 were completed laparoscopically. The mean operating time and hospital stay for laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, laparoscopic biliopancreatic diversion with duodenal switch, and biliopancreatic diversion was 111 ± 28 minutes and 4.3 ± 1.4 days, 195 ± 59 minutes and 3.9 ± 1.5 days, 248 ± 113 minutes, and 5.9 ± 2.6 days, and 203 minutes and 6.5 days, respectively. No patient died. Perioperative complications occurred in 4 patients (9.8%). The mean body mass index decreased from 41.5 ± 8 kg/m2 to 31.3 ± 6.8 kg/m2 during a mean follow-up period of 13.7 ± 9.6 months. Although laparoscopic biliopancreatic diversion with and without duodenal switch had the greatest preoperative body mass index, they achieved the greatest excess weight loss. ConclusionConversion of LAGB or nonadjustable gastric banding to laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion with or without duodenal switch is feasible and effective to treat the complications of LAGB and to further reduce the weight of morbidly obese patients.

A 5-Year Experience with Laparoscopic Adjustable Gastric Banding—Focus on Outcomes, Complications, and Their Management

Laparoscopic adjustable gastric banding (LAGB) remains the most popular surgical modality for obesity management in Europe. The aim of this publication is to present a 5-year experience in obesity treatment with LAGB operation with the assessment of outcomes, frequency of complications, and their management. Management of the band-related complications is crucial for continuous obesity treatments, despite the fact of initial failure, allowing further excess weight loss in patients with morbid obesity. One hundred sixty patients underwent the LAGB procedure with standard pars flaccida technique during the years2005-2009. A retrospective analysis of the data was performed; chi-squared test and Student's t test at the level of significance of p < 0.05 were used. Information on reoperations was gathered from hospital case notes. In the presented group, the mean body mass index (BMI) was 48.13kg/m(2) (33.46-83.04kg/m(2); standard deviation [SD] ±8.45). Of the patients, 36.2% had super morbid obesity with BMI >50kg/m(2). The mean observation period reached 549days (31-2,026days; SD ±390.1), with the mean number of control visits of 4.2 (1-12). The mean percentage of excess weight loss during the observation period was 34% (from -9.9% to 85.1%; SD ±20.6), with the mean body mass reduction of 24.4kg. Complications appeared in 30 patients (20.1%). Twenty-four patients (16.1%) required reoperation. There were no mortalities recorded. The mean operative time of 59min was relatively short. Morbidity and mortality rates were comparable to many published series. Failure or complications of LAGB did not stop the obesity treatment. Most of the band-related complications occurred late and could be provided for laparoscopically.

Bariatric Emergencies for Non-Bariatric Surgeons: Complications of Laparoscopic Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) has gained popularity for treatment of morbid obesity worldwide. With the widespread use of LAGB, an increasing number of medical specialists are dealing with the potentially life-threatening complications of this procedure. More than 6,000 LABGs were performed by our surgeons during the past 11years, during which various complications of LAGB were observed, including band slippage, erosion, gastric pouch dilatation, port infection, and disconnection. Complicated cases requiring emergency surgical intervention were collected. We present and discuss the diagnostic and therapeutic possibilities of these complications. Fourteen cases were identified: six with acute band slippage, two with small bowel obstruction, and one each with band slippage and fetal intrauterine growth restriction during the 36th week of pregnancy, perforated gastric ulcer, upper gastrointestinal bleeding, connecting tube penetration into a stomach ulcer, connecting tube penetration into the colon, and port disconnection. All patients had gastrointestinal symptoms at admission. Band reposition was performed in four cases; eight patients required band removal for band contamination. The band was open and still in place in one case. Open and laparoscopic gastric resections for necrotic stomach were performed in two cases. Suture of perforated gastric ulcer was combined with cesarean section. Connection of disconnected port and suture of colonic and gastric penetrations and perforation of fundus were completed laparoscopically. Small bowel resection and enterotomy required an additional minimal laparotomic incision. No mortality was observed in our series. Four patients elected to have the LAGB reinserted at a later time. The increasing number of bariatric procedures has resulted in emergency physicians' knowledge of serious complications of LAGB that require urgent surgical intervention. Treatment algorithms require early diagnosis and a surgical approach to solving these conditions.

An Unusual Complication 4 years After Laparoscopic Adjustable Banding: Jejunal Obstruction Due to the Connecting Tube

Laparoscopic adjustable gastric banding (LAGB) is an often performed bariatric procedure for morbid obesity. Several complications are known, including surgery and port-side-associated complications. As rare but serious late complication of LAGB, we describe a 50-year-old patient with periodic incomplete intestinal constriction due to the silicone connecting tube, 4 years after laparoscopic adjustable gastric banding was performed. Abdominal CT scan showed an obstructive ileus due to a loop in the connecting tube. After surgical removal of the connecting tube, the patient recovered without sequelae.

Radiological features of complications of laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is used to treat morbid obesity. We reviewed the associated complications with emphasis on radiological features and the role of radiology in suspected complications. Between 30 January 2001 and 3 October 2006, 313 consecutive LAGB patients' data was entered into a prospective database. A contrast swallow was routinely performed on the first postoperative day, and port adjustments were done at variable intervals. Additional radiological studies were performed in patients with suspected complications. Of 313 patients who underwent LAGB, 46 had 51 complications (16.3%). The commonest complications were LAGB system leakage (5.1%), anterior band slippage (3.5%) and infected port (1.6%). Two mortalities (0.6%), one early and one late, occurred. LAGB is a relatively low-risk procedure widely performed for treating morbid obesity. Imaging plays a pivotal role in the early evaluation and detection of LAGB complications.

A Serious but Rare Complication of Laparoscopic Adjustable Gastric Banding: Bowel Obstruction Due to Caecal Volvulus

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for the treatment of morbid obesity. LAGB complications have declined since its development in the early 1990s. However, LAGB complications are still occurring and can sometimes be serious and life threatening. These complications are related either to the band or to the access port, such as band slippage or tubing disconnection, retrospectively. We report a rare case of bowel obstruction due to caecal volvulus caused by connecting tube used in LAP-BAND system in a bariatric operation, which obstructed a caecal loop, in a female who had undergone LAGB 2 years previously. Diagnosis of bowel obstruction was established with plain abdominal radiograph appearances. Follow-up abdominal computed tomography findings confirmed the diagnosis of caecal obstruction and revealed the underlying cause for this obstruction. Surgery was performed, and intraoperative examination demonstrated that connecting tube of the LAP-BAND system was a main causative factor. We can hypothesize that bowel obstruction secondary to LAGB operation may become frequently diagnosed as more LAGB operations performed worldwide. The emergence of many problems, such as this, can be minimized with enhancement in the development of better surgical materials, proper operative technique, and close postoperative management and follow-up.

Perforation of an Adjustable Gastric Banding Connecting Tube into distal Transverse Colon with Intra-luminal Migration

Laparoscopic adjustable gastric banding (LAGB) is one of the most common bariatric procedures performed in Europe and Australia. Major post-operative complications are limited but once they occur, prompt diagnosis and treatment are mandatory. LAGB complications are related either to the port and the connecting tube, such as infection or tubing disconnection and migration, or to the band, such as slippage, pouch dilatation, or intra-gastric migration. We report a case of intra-colonic migration of the connecting tube occurring 4 years after gastric banding placement in a patient otherwise asymptomatic.

AH-04: Laparoscopic adjustable gastric banding complications and outcomes in a single U.S. center with four-year follow-up

Our center has performed 406 Laparoscopic Adjustable Band procedures since December 02, all with the Para Flaccida Technique with port placement in the left upper quadrant. All Adjustable Bands were placed by the same surgeon. All patients received dietary and behavioral instruction regarding the use of the Gastric Band both Pre-op and Post-op.

First Experiences with Laparoscopic Adjustable Gastric Banding (LAGB) in the Treatment of Patients with Childhood Craniopharyngioma and Morbid Obesity

Craniopharyngiomas are embryogenic malformations which lead to eating disorders and morbid obesity due to hypothalamic involvement in about 50% of all patients with pediatric craniopharyngioma. The experience with laparoscopic adjustable gastric banding (LAGB) in obese craniopharyngioma patients is limited. We are reporting on four patients with childhood craniopharyngioma diagnosed at age 2, 11, 12, and 21 years. BMI-SDS at diagnosis was +0.9, +4.5, +4.7 and -0.1 SD. During follow-up, all patients developed morbid obesity (BMI-SDS: +13.9, +10.3, +11.4, +7.3) so that 11, 6, 9 and 3 years after diagnosis LAGB were performed. After a follow-up of 4.5, 1.5, 3.0 and 2.5 years BMI decreased or stabilized continuously in all patients (BMI-SDS at latest visit: +9.9, +9.7, +9.5, +5.9 SD). The eating behavior changed in all patients profoundly. The addiction to food and especially sweets significantly improved based on self-assessment. In two patients a dislocation of the LAGB occurred and resulted in weight gain. We conclude that LAGB could be effective in weight reduction of obese craniopharyngioma patients with hypothalamic syndrome. Close follow-up is necessary in order to analyze long-term effects and complications of LAGB in patients with childhood craniopharyngioma and morbid obesity.

An Unusual Complication of Gastric Banding: Recurrent Small Bowel Obstruction Caused by the Connecting Tube

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for morbid obesity. The application of this mini-invasive approach has given the benefits of shorter hospital stay, less postoperative pain and quicker functional recovery. LAGB complications are related either to the access-port, such as port-site infection or tubing disconnection, or to the band, such as band slippage, pouch dilatation, or intragastric migration. We report a case of recurrent small bowel obstruction caused by the connecting tube around a jejunal loop, in a woman who had under-gone LAGB 3 years before. The diagnosis was difficult to establish because the clinical history and examination were non-specific. A 3-dimensional CT scan was needed to explain the cause of the recurrent abdominal pain, and the small bowel loop was freed from the connecting tube at laparoscopy.