The importance of patient selection in bariatric surgery: One not fit for all. Case report of a preventable double severe complication after Laparoscopic gastric banding positioning

Highlights • LAGB presents many severe complications. • Wedge resection could allow to preserve a tailored gastric pouch limiting postoperative nutritional defects. • Strict postoperative follow-up reduce the risk of severe complications.
Introduction Laparoscopic adjustable gastric banding (LAGB) is a minimal invasive, effective and reversible procedure, even if it is burdened by life threatening complications. Presentation of the case A 39 years-old female patient was admitted to our emergency department for abdominal pain and ileus and underwent an explorative laparoscopy. The LAGB was wrapped around the proximal portion of the stomach determining the erosion and ischemia of the great curvature region. It was removed and a large gastric resection of the great curvature was performed. Subsequently, a gastric leak with pleural abscess occurred with the beginning of the oral diet. It was successfully treated with fasting, intravenous antibiotics and a thoracic tube. Discussion LAGB is a restrictive procedure that compartmentalizes the upper stomach by placing a tight adjustable band around it. However severe and multiple complications can also occur. Slippage is one of the most frequent and dangerous complication. Partial gastric resection (comparable to sleeve gastrectomy) or total/subtotal gastrectomy on the limit of the scarring tissue is use requested in the latter case, with a high risk of postoperative leak. A strict postoperative follow-up is mandatory in order to early recognize any severe complications. Conclusion Strict follow-up in this special subset of patients, the bariatric ones, is mandatory in order to early identify and correct any postoperative complications, avoiding severe sequelae.