Death-related gastric necrosis after Laparoscopic Adjustable Gastric Banding in the early post-operative period
© Fragkouli et al; licensee BioMed Central Ltd. 2010
Received: 6 August 2010
Accepted: 11 October 2010
Published: 11 October 2010
We report a case of a rare complication of Laparoscopic Adjustable Gastric Banding (LAGB) as a cause of death in the immediate post-operative period. The number of relevant reports and postmortem images presented in the literature is extremely restricted. Gastric necrosis may constitute a cause of death after LAGB in the early post-operative period. Postmortem examination reveals the extension of gastric ischemia and necrosis, responsible for the lethal outcome. To date, only one case of gastric necrosis after LAGB in the immediate post-operative period leading to death has been reported, according to authors' knowledge. The diagnosis of this complication may be delayed on the grounds of its rarity. In our opinion, surgeons should be aware of the clinical state implying gastric ischemia early after LAGB, so as to recognize and, in turn, to treat it promptly.
A considerably high number of surgeons worldwide prefer to treat morbid obesity by means of Laparoscopic Adjustable Gastric Banding (LAGB), a restrictive bariatric technique used to reduce gastric volume. The procedure's technical simplicity and relative safety have rendered it one of the most common surgical techniques in Europe, Australia, Latin America and, recently, in USA [1–3]. However, despite its popularity, LAGB is related to serious complications, both early and late, that usually raise the demand of a second operation or even lead to a fatal outcome if not recognized . Latest data place the incidence of LAGB's complications at the figure of 12.2% . The most frequent complications are device-related and, in recent years, their incidence appears essentially decreased, owing to modifications in the surgical approach. Band slippage/gastric prolapse presents the highest reported frequency of approximately 4.5 - 5% . Among other complications, bleeding, pouch dilatation, anastomotic leaks and gastric perforation are included. On the other hand, although data about mortality after LAGB is rather restricted, the recently reported percentages range from 0.34% to 0.51% and the most common causes of death are pulmonary embolism and myocardial infarction [4, 5].
Gastric necrosis represents a rare but life-threatening complication of gastric banding, that may appear in the early post-operative period and it is possible to lead to death if untreated.
Gastric necrosis is a rare complication of LAGB; its diagnosis is often delayed and, when present, comprises a medical emergency. Although the rich blood supply of the stomach, with its extensive intramural anastomoses, render the organ resistant to ischemia, a combination of comorbidities existing in obese individuals along with the risks of LAGB itself may result in gastric necrosis.
To our knowledge, only one case of gastric necrosis after LABG in the immediate post-operative period leading to death has been reported to date .
Conclusively, gastric necrosis after LAGB constitutes a potentially lethal complication of the procedure, emerging even as a short-term one. In our opinion, surgeons should be aware of any clinical signs indicating a gastric necrosis so as to recognize it promptly and manage it properly.
- Cunneen SA: Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008, 4 (Suppl 3): s47-55. 10.1016/j.soard.2008.04.007.View ArticlePubMedGoogle Scholar
- Provost DA: Laparoscopic adjustable gastric banding: an attractive option. Surg Clin North Am. 2005, 85: 789-805. 10.1016/j.suc.2005.04.004.View ArticlePubMedGoogle Scholar
- Chandler RC, Srinivas G, Chintapalli KN, Schwesinger WH, Prasad SR: Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. Am J Roentgenol. 2008, 190: 122-35. 10.2214/AJR.07.2134.View ArticleGoogle Scholar
- Gagner M, Milone L, Yung E, Broseus A, Gumbs AA: Causes of early mortality after laparoscopic adjustable gastric banding. J Am Coll Surg. 2008, 206: 664-9. 10.1016/j.jamcollsurg.2007.11.014.View ArticlePubMedGoogle Scholar
- Carelli AM, Youn HA, Kurian MS, Ren CJ, Fielding GA: Safety of the laparoscopic adjustable gastric band: 7-year data from a U.S. center of excellence. Surg Endosc. 2010, 24: 1819-23. 10.1007/s00464-009-0858-8.View ArticlePubMedGoogle Scholar
- Dargent J: Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure - a 9-year series. Obes Surg. 2004, 14: 986-90. 10.1381/0960892041719545.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.