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Complications

  • 1. Nausea/vomiting: This can be usually managed with anti-emetics, prokinetics, antacids and adequate hydration. A recent systematic review reported that 8 % of patients who underwent gastric plication developed nausea and vomiting [15]. The feeling of postoperative gastric fullness or gastric spasm was the possible reason, which would subside after adaptation [11]. Most cases resolved within a week with PPI’s, anti-emetics, and anti-inflammatory drugs without requiring admission.
  • 2. Acute gastric obstruction: A too tight plication can result in acute gastric obstruction and will require emergent release of plication sutures. This condition settles promptly after the reversal of plication.
  • 3. Herniation of plicated stomach: Gastric fold herniation (GFH) is a devastating complication after greater curvature plication with an incidence varying from 0.1 to 7.6 % [17, 19, 26]. It is defined as the herniation of gastric tissue through the plicated stomach sutures. Patients who present with intractable abdominal pain or vomiting following LAGBP require urgent radiological studies, such as upright plain films or abdominal CT, to exclude the possible existence of GFH. In the upright abdominal plain film, GFH can be diagnosed by the presence of a gastric bubble. An abdominal CT is the most sensitive study, which will typically demonstrate bulging of the herniated segment from the plicated stomach. GFHs usually warrants urgent reoperation once diagnosed. If left untreated, the congested stomach would eventually progress to full thickness ischemia, necrosis, and even perforation. The surgical options would be deplication of the sutures, resection of the herniated segment, and removal of the adjustable gastric band or re-plication. We postulated that the incidence of GFH was multifactorial, resulting from early and late. Early GFH, which occurred within a week, could be attributed to technical issues such as edematous stomach, inappropriate suture material, widely placed plication sutures, and forceful vomiting. Late causes could be due to disruption of the suture line as seen in chronic vomiting and raised intragastric pressure [11].
  • 4. Gastric perforation: This is a rare but serious complication of LAGBP. A high degree of clinical suspicion is important. Pain, tachycardia and high leukocyte count should raise the surgeon’s alarm. Computed tomography of abdomen or contrast study may be performed but in the end, clinical judgment must prevail.

Laparoscopic exploration should be performed earlier, band removed and plication must be released. Perforation can usually be repaired primarily. However, wedge resection or sleeve gastrectomy may be required for the ischemic part.

  • 5. Band erosion or infection: As with LAGB, band may get infected and usually needs removal.
  • 6. Band slippage: It can present with persistent vomiting and severe GERD. X-ray can detect the loss of 45° angle between band and horizontal line. Mostly it needs removal of band which can be replaced 3 months later.
 
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