Emergencies of Adjustable Gastric Banding
Adjustable Gastric Banding (AGB) procedures have been presented and promoted as innocuous and low risk in nature. AGB still carries significant risks although its perioperative complication rate appears to be less compared to other weight loss surgical procedures. Such risks include permanent and potentially life-threatening damages or other complications if proper treatment isn’t sought in an urgent manner.
Often times a patient’s complaints are minimized and blamed on behavior or their presumed non-compliance. Quite frequently they are only referred to a surgeon after exhaustive workup has been completed and mostly reported back as normal. These workups include upper GI series and endoscopic studies. Nevertheless, the complication(s) with which a patient may have been presented with still continue.
I would like to discuss two such examples in which patient care may have been delayed.
The first patient was a 45-year-old male who had the AGB procedure completed approximately two years prior to her first visit to our office. He presented complaints of abdominal pain and worsening reflux. He had had multiple adjustments at his primary surgeon’s office and was told to be in the optimal “green zone” for the band. He had lost approximately 45% of his excess weight, but continued to have significant debilitating reflux.
An upper endoscopy was reported to be normal and consistent with a properly placed band. An upper GI performed months later identified a dilated esophagus, requiring the band to be removed. In hindsight, the band should have been completely emptied upon the patient’s first complaints of abdominal pain and reflux.
The next patient visited a local emergency room with acute onset of nausea and vomiting. She was sent home with a diagnosis of gastroenteritis and instructed to follow up with her primary care physician. She returned back to the emergency room within 36 hours with a progressively worsening nausea and vomiting. She was admitted and underwent an upper endoscopy after which a surgical consultation was obtained. The patient was taken to the operating room with a diagnosis of “slipped band”, and had to have the band removed emergently. Looking back at this case, the abdominal x-ray was suspicious for a slipped band. She should have been referred for surgical care at the time of her first emergency room visit.
Ultimately, the burden of proof is on the medical provider treating the patient with an AGB to ensure that there is no slippage when the patient presents with acute changes in his or her condition. The AGB may still “appear” to be in the proper place and adjusted with the patient still having symptoms of reflux, inadequate weight loss, and abdominal pain. These patients would require surgical intervention and probably removal of the band.
As indicated earlier, the patients’ complaints should not be discounted as being a compliance issue and instead should be referred for surgical evaluation.