Complications following gastric banding

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There are many complications that can occur following gastric banding. It is helpful to divide these into early and late post-surgical complications.

Clinical presentation

Although the exact mode of presentation can vary depending on the underlying complication common modes of presentation that lead to imaging evaluation include abdominal pain, retching and vomiting.

Pathology

Early complications
Late complications

Radiographic features

Fluoroscopy is a versatile tool in assessing for potential gastric band complications. It can not only demonstrate most complications, but also supports percutaneous adjustment of band inflation and dynamic stoma assessment.

CT has the advantage of demonstrating other causes of abdominal pain in these patients and is increasingly used in their acute assessment. This is usually performed with the administration of 15-20 mL water soluble oral contrast agent prior to assessment.

Band malposition

This is usually evident on plain radiographs with an abnormal Phi angle (out with accepted normal 4° - 58° range) and band lie. The band can be misplaced into perigastric fat or distal stomach with complicating outlet obstruction.

Gastric perforation

This is rare, reported in < 1% of patients. On fluoroscopy, it is evident as contrast tracking outside the gastric outline.

On CT there is extra-luminal contrast, penetration of the gastric wall by the band, localized gas locules or pneumoperitoneum.

Pouch dilation

This is seen as concentration dilation of the gastric stoma and results from stomal stenosis, adhesions or nutritional overload. Findings include a tight stoma with delayed gastric emptying. Axial herniation of the stomach, esophageal reflux and dilation can occur as late complication.

Band slippage

This can occur with either anterior or posterior upward herniation of the distal stomach upwards through the band, usually with an abnormal Phi angle. There is typically resultant eccentric (as opposed to concentric) pouch dilation.

Gastric erosion

Fluoroscopic examination can be normal in the early stages of intragastric erosion. Later on, oral contrast is seen pooling around the band tubing outside of the gastric lumen.

CT may show eccentric gastric thickening with invasion of the band into the gastric lumen. Sometimes locules of gas are seen within the gastric wall underlying the band.

Esophageal dilation or dysmotility

This is demonstrated fluoroscopically. Secondary complication from dysmotility or dilation such a gastro-esophageal reflux, esophagitis and aspiration may also be demonstrated. Gastroesophageal reflux disease (GERD), a common side effect, is seen in about 12–22% of patients with gastric banding .

Connector tube or port complications

1-8% of the complications are related to the port site which are usually infections and abscesses. Port inversion is seen in 1% of cases. Band break or opening is the most infrequent complication, seen in only 0.3–0.5% cases .

Tube disconnection can be visible on radiographs as a discontinuity in the tube catheter. This is usually at the junction with the port or band. Fluoroscopic examination with the injection of 5 mL of contrast into the tube port can show a contrast blush to confirm the site of leakage.

The port-site infection which is not evident externally can be assessed with ultrasound to look for abscess formation.

See also