The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity

Background: Morbid obesity is effectively treated by restrictive surgery. A severe complication associated with gastric banding is gastric erosion. We review here our experience over a 5-year period. Methods: A total of 1496 patients underwent gastric banding. Eighty-five percent of patients were available for follow-up. When band erosion was diagnosed, laparoscopic removal was performed. Results: Band erosion was identified in 17 patients (1.13%). The time from primary operation to diagnosis of band erosion ranged from 3 weeks to 45 months (mean, 19 months). Clinical manifestations included weight gain in 2 (11.6%), band system leak in 1 (5.8%), chronic port-cutaneous fistula in 2 (11.6%), neglected peritonitis in 1 (5.8%), left subphrenic abscess in 2 (11.6%), but most commonly, protracted port-site infection that occurred in 7 patients (40.6%). Conclusions: Patients were effectively treated by band removal and suturing of the stomach wall. We suggest that different pathologies contribute to the same complication depending upon the time of presentation. We recommend a high index of suspicion in order to diagnose this life-threatening complication.