1. Intermittent gastric prolapse after adjustable gastric banding is a potential cause of band intolerance: clinical and diagnostic findings from eight patients.
- Author
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Clough AD and Moore PM
- Subjects
- Adult, Algorithms, Female, Follow-Up Studies, Gastroesophageal Reflux epidemiology, Gastroesophageal Reflux etiology, Gastroplasty methods, Gastroplasty statistics & numerical data, Humans, Laparoscopy adverse effects, Laparoscopy methods, Male, Middle Aged, Obesity, Morbid epidemiology, Periodicity, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications therapy, Prolapse, Reoperation statistics & numerical data, Retrospective Studies, Stomach Diseases diagnosis, Stomach Diseases epidemiology, Stomach Diseases therapy, Treatment Outcome, Weight Loss, Young Adult, Gastroplasty adverse effects, Obesity, Morbid surgery, Postoperative Complications etiology, Stomach Diseases etiology
- Abstract
Background: Gastric banding surgery can fail if the patient develops frequent vomiting, intolerance of common food types or reflux. These patients can be divided into those with a well-defined anatomical problem such as slippage and those without. Intermittent gastric prolapse (IGP) is a possible explanation for some patients who do not achieve adequate early satiety without excessive food intolerance but have normal imaging., Methods: A series of eight patients was identified over a 2-year period with findings consistent with IGP. Cases were identified in the process of normal clinical practice and details reviewed retrospectively. Specific diagnostic methods included measures to increase pouch pressure above the band by either stress barium or endoscopy with pressure challenge., Results: The median time until diagnosis of IGP was 48.0 months (16-124), and weight loss over that time was 26.4 kg, or 69.6 % excess weight loss (EWL) (5.8-101.8). This fell to 43.7 % EWL after IGP was diagnosed and managed. The mean fill volume when the patients experienced IGP was 6.8 ml (4.5-9.0). Most patients were diagnosed by radiological investigation. Four patients underwent revisional surgery with the remainder treated conservatively., Conclusions: Intermittent gastric prolapse may explain excessive food and fluid intolerance in gastric band patients who have normal initial imaging. These patients typically experience gross food intolerance with a relatively small increment in fluid volume with relief when the increment is removed. The diagnosis is best made with either modified stress barium or endoscopy with pressure challenge. Management entails establishment of a safe fill volume, modification of weight loss expectations and earlier discussion of revisional surgery.
- Published
- 2015
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