Post-Operative problems: LapBand

WARNING: Unpleasant symptoms occurring after Obesity Surgery can indicate a progressing and/or life threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.

EARLY PROBLEMS (the first 7-10 days after surgery)

In general the first week after surgery is an important period to monitor for problems. Leak and bleeding, which are the most serious problems, tend to occur just after surgery and are less likely later in this period. In comparison with Gastric Bypass there are fewer early problems during and after LapBand placement; however, long-term problems may be just as frequent with the LapBand. Thus, it is important to contact the surgeon immediately if you are having new problems. This applies for the rest of the patient’s life.

Bleeding

Unlike Gastric Bypass bleeding after LapBand placement is very rare and usually occurs within the first 24 hours. Approximately 1 out of 1000 patients who have a Lapband will have significant bleeding requiring blood transfusion or re-operation. Symptoms of blood loss are dizziness (especially on standing), shortness of breath, a rapid pulse (> 100 beats a minute), a pale appearance and minimal or no urine production. As stated, signs of significant blood loss may require an urgent re-operation in the first 24 hours.

Stomach Leak        

This is a life threatening complication. Fortunately, stomach leak after LapBand is extremely rare, occurring in 1 out of 2000 patients. It occurs when an injury is created in the stomach wall during LapBand placement allowing stomach juice to escape into the abdominal cavity. A severe infection develops that can lead to sepsis (adverse symptoms involving all body systems) or septic shock (low blood pressure with injury to all body systems). Multiple Organ Failure can occur which is basically a shut down of many organ systems. With time this can lead to death.

Symptoms of stomach leak include: rapid heart rate, dizziness, shortness of breath, fever, worsening abdominal pain, abdominal distention, the appearance of illness and a general feeling that something is very wrong. Unfortunately, many of the symptoms may be absent or could be from something else (e.g. bleeding). Diagnosing a leak is further complicated by the fact that there is no single, reliable test to definitely diagnose a leak.

The diagnosis of a leak must be clinical, that is, the surgeon must consider all symptoms in relation to the timing after surgery. The diagnosis can never be 100% sure before treatment. If a leak is suspected the patient must go back to the operating room for an OPEN SURGERY to close the hole and clean up the leak. Usually, the patient will need to spend some time in the Intensive Care Unit (ICU) and rarely may require mechanical ventilation, temporary dialysis, and/or medications to support the blood pressure. Clearly, the key factor with a bowel leak is an early return to the operating room, even if the diagnosis is not assured.

Blood Clots

This is a rare problem which occurs in less than 1% of patients. Obese patients are more prone to developing blood clots in the veins of the legs than are normal weight patients. The clot is dangerous because if it were to break off it might travel up the blood stream to the lung where is could suddenly decrease blood flow. This is known as a pulmonary embolism and frequently is fatal. The treatment is PREVENTION of the formation of blood clots. Our patients are given a short-acting blood thinner before surgery and sequential leg squeezing devices are fitted over the legs during the operation. Although, both of these are somewhat effective, neither is anywhere near as effective as the main treatment, which is getting out of bed and walking within 2 hours of the end of the operation. EARLY MOBILIZATION is the key to preventing blood clots. It is the most important thing the patient can do for him/herself around the time of the surgery.

Abdominal Abscess

This is a very rare problem if a stomach leak has not occurred first. An abscess is a collection of pus localized to one area of the abdominal space (i.e. a contained infection). Symptoms include a rapid heart rate, fevers, and occasionally abdominal distention with or without vomiting. Usually, this will take longer to develop than a leak and will not progress as fast. An abscess can be diagnosed by CT scan and the treatment of choice is to have the radiologist place a drain into the cavity to drain the pus. Rarely re-operation will be required. The patient will need to stay in the hospital on antibiotics until the abscess clears.

Wound Infection

A wound infection is an infection of one of the incision sites, typically occurring 7-10 days after surgery. The incision will be red and warm, with thickening of the skin, sometimes accompanied by pus discharged from the wound. The patient may have fever. It should be noted that a small amount of redness along an incision is normal, and when this is not accompanied by the other signs is unlikely to be an infection. Treatment requires opening of the wound (to let the pus out), daily dressing changes of gauze to the wound base, and oral antibiotics. The patient will not need to stay in the hospital unless the infection is progressed or he/she has a vulnerability to infections (e.g. diabetes).

LONG TERM PROBLEMS (can occur any time after surgery)


Chronic Infection

The LapBand System is an implant. It is a foreign body made out of silastic and titanium that can remain within the body for decades. However, if bacteria become entrenched in and around a LapBand it may be impossible to get rid of them with antibiotics, because antibiotics can not penetrate the plastic. Very rarely a wound infection around the LapBand port will become a chronic infection that antibiotics will not cure. Even more rarely an infection – such as an abscess – will form around some part of the system on the inside of the abdomen. Infections like these require that part or all of the LapBand System be removed. The risk of a chronic infection requiring removal of part or all of the system is 1 in 200 patients. Chronic port infections can be cured by removing the infected port and reconnecting the LapBand tubing to a new, clean port in an alternate site.

Prolapse

Prolapse, or slippage, of the LapBand occurs when the Lapband slides down the stomach to a lower position. No one is sure how this happens; however, it is likely a consequence of recurrent vomiting, possibly from over-tightening of the band or swelling of the channel from overeating. The incidence of this event is approximately 3% (1 out of 30 patients). It is the most common long-term problem that happens to LapBand patients. Unfortunately, a change in the position of the LapBand can cause serious symptoms. A slight prolapse can lead to heartburn, occasional vomiting and weight gain (from a larger pouch). A more profound prolapse causes a greater change in the angle of the band, with more distortion of the now larger stomach pouch. This can result in a complete obstruction of the stomach at the level of the band, or, in extreme cases, compromise of the stomach wall.

Initial treatment of a suspected low grade prolapse is removal of all of the saline from the LapBand System. This may allow the band to assume a more favorable position and allow the patient to take liquids or even solid easier. Occasionally, a patient will have a complete resolution of his/her symptoms and can later have the band re-adjusted. Conversely, a more significant prolapse will require surgery to correct. Usually this can be accomplished by repositioning the band back up to its original, higher location. Removal of the band is rarely required.

Erosion

An erosion is when the LapBand rubs a hole completely through the wall of the underlying stomach leading to a contained infection. This is a rare complication in our experience with an incidence of 1 in 500 patients. An erosion allows infected stomach juice to track out around the band, even along the tubing between the band and the port. A classic sign of erosion is the appearance of an infection around the port – redness, warmth and tenderness – many months after the Lapband was placed. This occurs because the infection has tracked all the way up to the port. An erosion can be diagnosed by an endoscopy of the stomach because the band should be visible from inside the stomach. Erosion will require removal of the LapBand to allow the hole to close and the infection to be cured.

Port Problems

A number of problems can occur after port placement including a flipped port, an acutely angled port, and port leak. These problems can be corrected with a minor surgery - by repositioning or replacing the port - in a matter of minutes. Unfortunately, that does mean surgery, but the risks of these operations are low as the abdominal space is not entered, and the band itself is not manipulated.

IMPORTANT: The problems above are a partial list of all possible complications that can occur after this procedure. Some complications are rare and may be beyond the experience of the surgeon or even the surgical literature. Complications are usually not foreseeable.

WARNING: Unpleasant symptoms occurring after Obesity Surgery can indicate a progressing and/or life threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.