Emergency gastrectomy for gastric necrosis 5 years after laparoscopic adjustable gastric banding (LAGB)

Abstract

Laparoscopic adjustable gastric banding (LAGB) is currently one of the most common bariatric surgical procedures performed worldwide for the treatment of morbid obesity. Among bariatric surgeries, the percentage of LAGB has increased from 24.4% to 42.3%. In North America alone, the number of LAGB procedures has increased exponentially by 944.2% (from 9,270 to 96, 800 cases). Though early and late complications following LAGB are well-understood, data regarding long term complications remains indefinite due to the limited follow-up periods. We report a case of acute gastric necrosis associated with band slippage presenting as a surgical emergency five years after LAGB. Gastric necrosis represents a rare, but life threatening complication of gastric banding that has been reported in the early post-operative period. To the best of our knowledge, this case report is the longest time-interval reported between LAGB and the diagnosis of this very rare complication. Accurate diagnosis is often delayed due to its rarity and nonspecific clinical presentation. Increased awareness of this delayed complication should facilitate early recognition as it often requires urgent surgical intervention to prevent fatal outcomes.