Complications of Adjustable Gastric Banding Surgery for Obesity



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Am Fam Physician. 2014 May 15;89(10):813-818.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Laparoscopic adjustable gastric banding procedures have a favorable risk-benefit profile and are increasingly important as part of the overall management of obesity. These procedures are effective at inducing weight loss and improving comorbid conditions, including diabetes mellitus, hypertension, and sleep apnea. Laparoscopic adjustable gastric banding has several typical complications, and family physicians should recognize these as part of a team-based approach to the management of obesity. Gastric band slippage, port or tubing malfunction, stomal obstruction, band erosion, pouch dilation, and port infection are examples of complications that may occur after laparoscopic adjustable gastric banding. Upper gastrointestinal tract imaging is often required to diagnose these complications. Some complications can be managed in the primary care setting through behavioral diet modification or removal of fluid from the band (band deflation); however, other complications require surgical repair or removal of the band.

Surgery for morbid obesity has become an integral part of managing this common and serious chronic illness, and it is the only therapy proven to induce sustained weight loss. Previously considered an option of last resort, surgical management of obesity now has a more favorable risk-benefit profile and is appropriate earlier in the course of management. Although there are risks with bariatric surgery, these procedures have been shown to have low rates of surgical mortality comparable to those of other commonly performed procedures.1 Current bariatric procedures result not only in substantial weight loss but also in improvements for many associated comorbid conditions, such as diabetes mellitus, hypertension, and sleep apnea.2 The number of bariatric procedures performed has increased dramatically over the previous decade, although it has plateaued to approximately 113,000 cases per year in the United States.3 Approximately 1% of eligible patients with morbid obesity undergo bariatric surgery.4

Laparoscopic adjustable gastric banding is the most common form of bariatric surgery in the United States,5 although the use of laparoscopic sleeve gastrectomy may be increasing.6 Despite favorable mortality and weight loss outcomes, there is growing evidence of long-term complications following gastric banding, which are often not identified in short-term clinical studies.7 Approximately 50% of patients require reoperation,8 including 25% who experience major late complications. Up to 73% of patients would not choose to have laparoscopic adjustable gastric banding surgery again.9

In addition to patient counseling, education, and referral for surgery, family physicians may treat patients for follow-up after bariatric surgery or for specific symptoms in the office or emergency department. Family physicians must be able to identify common postoperative problems and evaluate the need for further intervention.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Laparoscopic adjustable gastric banding surgery is effective in reducing weight and improving comorbid conditions in patients with obesity.

C

1, 2

Assessing the port system integrity and performing upper gastrointestinal imaging are the best initial steps to assess abdominal pain, vomiting, or dysphagia after laparoscopic adjustable gastric banding.

C

7, 1113

Repair of hiatal hernia at the time of laparoscopic adjustable gastric banding surgery reduces the need for subsequent reoperation.

C

23


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Laparoscopic adjustable gastric banding surgery is effective in reducing weight and improving comorbid conditions in patients with obesity.

C

1, 2

Assessing the port system integrity and performing upper gastrointestinal imaging are the best initial steps to assess abdominal pain, vomiting, or dysphagia after laparoscopic adjustable gastric banding.

C

7, 1113

Repair of hiatal hernia at the time of laparoscopic adjustable gastric banding surgery reduces the need for subsequent reoperation.

C

23


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Definitions

The Authors

CHARLES KODNER, MD, is an associate professor in the Department of Family and Geriatric Medicine at the University of Louisville (Ky.) School of Medicine.

DANIEL R. HARTMAN, DO, practices at Brentwood (Tenn.) East Family Medicine. At the time the article was written, Dr. Hartman was a resident in the Department of Family and Geriatric Medicine at the University of Louisville School of Medicine.

Address correspondence to Charles Kodner, MD, University of Louisville School of Medicine, Med Center One Building, Louisville, KY 40292. Reprints are not available from the authors.

REFERENCES

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