Laparoscopic management of gastric band erosions: a 10-year series of 49 cases

Intragastric erosion is a rare but major complication of laparoscopic adjustable gastric band (LAGB) surgery for morbid obesity. Many techniques to treat this problem have been described, with little supporting evidence. The authors review their experience with laparoscopic removal of eroded gastric bands. The prospectively collected bariatric surgery database of the authors' practice was queried for the period January 2000 until February 2011, and the medical records for all patients with the diagnosis of band erosion were reviewed. Symptoms, time to erosion, interval between diagnosis and treatment, and complications of treatment were reviewed. All patients had undergone laparoscopy, cut-down onto the band, unclasping or division of the band near the buckle, removal of the band, and primary closure of the gastrotomy with omental patch reinforcement. During the study period, 2,097 LAGB operations were performed and 53 (2.53%) of these resulted in intragastric erosion. All the bands placed were LapBands (Allergan, Inc., Irvine, CA, USA). Erosions occurred with 14 of the 10-cm bands, 11 of the Vanguard bands, 14 of the AP Small bands, and 14 of the AP Large bands. Three patients elected to have their revisional surgery elsewhere and thus were lost to follow-up evaluation. One patient declined to have her band removed. The remaining 49 patients were included in the analysis. The mean time from band placement to the diagnosis of erosion was 31.5 months, and the mean time from diagnosis to band removal was 32 days. The mean hospital stay was 4 days. The complications included one postoperative leak, four superficial wound infections, and one pleural effusion. There were no deaths. This review demonstrates the safety of laparoscopic removal of eroded gastric bands with primary closure and omental patch repair. The time from diagnosis of erosion to treatment can be short, in contrast to endoscopic removal, in which the requirement for further erosion of the band to free the buckle often necessitates delayed treatment.