Weight Regain After LABG: Ponder to Intra-gastric Migration
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Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive procedure with the lowest morbidity and mortality rates among the common bariatric procedures. The advantage of LAGB is that it does not permanently modify the anatomy of the stomach and maintains the natural continuity of the alimentary tract, thereby permitting other bariatric procedures in case of failure to lose weight or complications in morbidly obese patients. 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 presented with progressive weight gain for the last 8 years. The patient had a sedentary lifestyle with BMI of 45.03 and hypertension as co-morbidity. Clinically the patient was euthyroid with central and peripheral obesity, weight 96 kg, and height 146 cms. After 4 months of diet regime and 3kg weight loss, the patient opted for LAGB. The patient underwent LAGB by pars flaccida technique, 50 cc gastric pouch was created using Lap BandTM. The patient recovered uneventfully and discharged on day 3 with dietary advice.

The patient started losing weight with 83 kg at 6 weeks and 75 kg at 3 months. However patient noticed sero-purulent discharge from the epigastric port site after three months, oral gastrograffin study was performed which was normal. Persistent discharge led to wound exploration and infected band tubing was removed. The patient recovered well and kept following at regular intervals. The patient again noticed a 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, the however band seemed lower in position as compared to previous gastrograffin series.

UGI endoscopy showed a part of the circumference of the band in the gastric cavity confirming intra-gastric migration and was not retrieved due to adhesions with the gastric wall. In view of recurrent discharge and patient’s request (weight 68kg), band removal was planned. The procedure was started laparoscopically, intraoperative dense adhesions were found between the left lobe of the liver and anterior wall of the stomach, the band was not visualized. The procedure was converted to open after no progress with dissection due to dense adhesions. After meticulous dissection around the stomach, the band was felt in the lumen of the stomach. The band was delivered out through gastrotomy made on anterior wall and stomach closed in two layers. The patient recovered well and was discharged on day 6. The patient is healthy in follow-up and all wounds healed well.

Source: http://www.mamcjms.in/article.asp?issn=2394-7438;year=2020;volume=6;issue=2;spage=139;epage=142;aulast=Bains