Perigastric band abscess: laparoscopic approach

Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual. Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.

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Perigastric band abscess: laparoscopic approach

Authors

M Vix, F Costantino, J Marescaux

Abstract

Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.

Type de vidéo

Vidéo chirurgicale

Durée

07'22''

Publication

2010-03

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E-publication

WeBSurg.com, Mar 2010;10(03).
URL: http://www.websurg.com/doi-vd01en2886.htm

Perigastric band abscess: laparoscopic approach

1. Introduction 00'07''

This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual. Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch. Indeed, this pouch made satisfactory weight loss difficult and the patient no longer felt the wanted satiation.

2. Intraperitoneal adhesions 00'40''

After introduction of the trocars, we notice the presence of various typical adhesions subsequent to the placement of a gastric band between the stomach and the liver.

3. Dissection of the adhesions 00'49''

The first step will consist in the resection of these adhesions between the omentum, the stomach and the liver. This dissection is not always easy; it is important to identify the various organs and recreate the anatomy so that it is understandable.

4. Gastric band identification 01'13''

The gastric band is easily identified by its catheter, which will be followed while gradually taking down the various adhesions. We begin to split the band’s shell around the catheter and we find denser adhesions between the gastric wall, the liver and the portion of the stomach that is situated around the band to block it.

5. Dissection of the band 01'51''

This dissection is uneasy and the correct landmarks need to be found in order to avoid a gastric lesion. While starting the dissection of the band, we are surprised to find that the silicone has a different coloration, and we rapidly uncover an abscessed collection. The whole collection is suctioned. This patient had no episodes of abdominal epigastric pains or gastric band blockages. We continue the band’s dissection in order to find its closure mechanism.

6. Peroperative gastroscopy 02'44''

One of the possibilities is that there is an intragastric penetration of the band; a peroperative gastroscopy is therefore performed: it reveals a mucosa with no particular break. We can therefore imagine that there was a micro traumatism of the band, leading to a fistula that has closed up since then. We continue to dissect the region round the band to try and find the superior portion of the stomach’s anatomy. Due to these various dense and inflammatory adhesions, we decide to resect the band only and not the band’s gastric cover. This is performed with a possible micro-perforation in mind. It is also possible that the band has started to migrate towards the stomach, but that this is not yet visible using the intraoperative gastroscopy. We enlarge the band’s exit point in order to identify the closure mechanism and obtain an easy division of the band. We see the band deep inside the gastric cover; the band is resected.

7. Pus identification around the band 04'46''

Some pus can be seen around the band’s mechanism, and it is immediately introduced in a bag in order to avoid a contamination of the abdominal cavity. The collection was analysed, revealing that it was sterile and germ-free.

8. Final gastroscopy control 05'11''

Another gastroscopy is performed along with an air-test, demonstrating that there are no leaks from where the band was removed; we therefore decide to perform a drainage. The gastric cover is not dissected. The patient’s postoperative course was uneventful, no gastric fistula was observed, the drainage was removed on postoperative day 5 and the patient resumed a normal food intake.