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LAGB removal

Strategies for LAGB removal to avoid medico-legal issues

The possibility of a retained foreign body should be in the differential diagnosis of any post-operative patient who presents with pain, infection or palpable mass

Hospitals should develop strategies for laparoscopic adjustable gastric band (LAGB) removal procedures to avoid medico-legal issues and bariatric surgeons should be involved in the evaluation of any patient who complains of abdominal pain if they have had a previous weight loss procedure as the bariatric surgeon is fully aware of the possible complications of the bariatric surgeries, claim researchers for Aleppo University Hospital, Aleppo, Syria and the Ohio Clinic, Dubai, United Arab Emirates. The noted that surgeons performing band removal should be aware of the possible pitfalls and complications of this procedure.

In the paper, ‘Retained gastric band port and tube 5 years after gastric band removal and laparoscopic Roux-en-Y gastric bypass: a case report’, published BMC Surgery, the investigators reported a rare case of retained gastric band port and the attached tube five years after gastric band removal and laparoscopic Roux-en-Y gastric bypass.

Case report

The researchers report that a 31-year-old Caucasian female presented to the outpatient clinic five years after her last surgery complaining of a left upper quadrant abdominal mass, the mass size increased gradually over the last two years. The patient had a LAGB ten years ago and five years later she had a revision surgery (due to weight loss failure), when the gastric band was removed and she had a laparoscopic Roux-en-y gastric bypass.

On examination, the patient did not have a fever and the abdomen was soft and non-distended, a 4 × 4cm symmetric mass with normal overlying skin was found in the left upper quadrant. Laboratory findings including complete blood count, liver function tests, and renal function tests were within normal. The differential diagnosis was port site hernia or retained foreign body.

Further CT investigations of the abdomen and pelvis with oral contrast revealed subcutaneous spherical foreign body (probably the port) with the connected tube extending 10cm into the abdominal cavity (Figure 1). On exploration, the port with 10cm of the connected tube was found and removed through a small incision without laparotomy. The patient had an uneventful recovery and was discharged on the same postoperative day and she expressed her happiness because minimally invasive surgery was done.

Figure 1: CT of the abdomen and pelvis with oral contrast revealed subcutaneous spherical foreign body (probably the port) with the connected tube extending 10 cm into the abdominal cavity

“Gastric band removal and laparoscopic Roux-en-Y gastric bypass can be a prolonged procedure when there are adhesions. Moreover, the surgical team becomes exhausted at the end of the procedure which may lead to such mistakes,” the authors said. “That was the case in our patient where the procedure time was 210 minutes, the retained foreign body was the port with the connected tube discovered five years after gastric band removal and laparoscopic Roux-en-Y gastric bypass.”

On review, the researchers noted that removal of the gastric band port was not mentioned in the patient’s medical record, subsequently, they suggested a checklist to be a part of the surgical notes of gastric band removal procedures. In addition, they added that the possibility of a retained foreign body should be in the differential diagnosis of any postoperative patient who presents with pain, infection, or palpable mass.

Furthermore, from a medico-legal standpoint, the authors recommended that surgical teams should be fully aware of the consequences of the retained foreign bodies and double check to avoid such cases. In this instance, the patient did not claim against the responsible surgeon for retained gastric band port but that does not apply to every patient.

“Detailed history and full clinical examination in addition to a high index of suspicion are mandatory to evaluate patients who have retained foreign body. Hospitals also should develop strategies for LAGB removal procedures to avoid medico-legal issues,” the authors conclude. “Finally, a bariatric surgeon should be involved in the evaluation of any patient who complains of abdominal pain and/or palpable mass if she/he has a previous weight loss procedure because the bariatric surgeon is fully aware of the possible complications of the bariatric surgeries.”

To access this paper, please click here

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