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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.

Large bowel obstruction by incarceration in the lesser sac through the foramen of Winslow is exceedingly rare and often associated with nonviable bowel at the time of operation according to older reports. In modern times, widespread availability of computed tomography (CT) for investigation of the acute abdomen may decrease the necessity of bowel resection in these cases. Here, we present a case of laparoscopic reduction of viable transverse colon from the lesser sac in a young woman. With the diagnosis suggested by CT, we were able to approach the case with two five millimeter working ports and 1 optical port, reducing the hernia by means of traction on the distal limb of transverse colon. The patient recovered well and was discharged on day 4 postoperative after bowel movement was achieved. Internal hernia represents one of the few cases in which laparoscopy may be the preferred approach to large bowel obstruction.