Surgical treatment and bandage erosion management of LAGB gastric prolapse

In some cases, especially when patients have mild symptoms and ambiguous imaging results, fluid can be drained from the bandage and observed in an outpatient setting.

After the patient enters the operating room, the straps are immediately loosened to relieve pressure on the stomach.

The position of the laparoscopic trocar is similar to that of the first surgery.

After establishing pneumoperitoneum, the adhesions were broken down to identify the stomach that had herniated into the ligature.

The bandage adjusts the bulging gastric sac and the previously folded folds.

Reduce protruding gastric sacs and re-cover folds.

If the stomach that has herniated into the band cannot be reduced, the band must be untied, a technically challenging task.

If the stomach that is herniated by the band cannot be reduced and the band cannot be untied, the old band should be removed and replaced with a new one.

The old bandages were cut and removed using scissors under laparoscopic guidance.

After opening and removing the bandage, re-establish the previous gastric tunnel, and insert the bandage as before.

Gastric pleiotropy is very important in preventing recurrent prolapse.

Postoperative management was similar to that of the previous surgery, and the same nutritional plan was used.

corrosion

Corrosion of the bandage, corrosion of the stomach wall, and the bandage entering the gastrointestinal tract all indicate that the implant has entered the stomach cavity.

It can occur in the first few months after surgery and is usually diagnosed within 2 years.

The tension of the stomach wrapped with bandages is directly related to erosion.

In the early experience of the second author in this chapter, suturing the bandage or raising the gastric fundus with a bandage was key to a high incidence of erosion.

However, there have been reports of the water infusion tube (rather than the bandage itself) penetrating the intestinal wall, without any apparent cause.

The incidence of gastric erosion is 1% to 4%.

The true incidence rate can only be known when all patients undergo gastroscopy.

Of the initial 600 patients examined by the second author of this chapter, 3.6% were diagnosed with gastric erosion between 18 and 36 months post-surgery.

Of these, 68% of patients presented with chronic sinus tracts or recurrent infections at the junction of sinuses.

Surprisingly, 32% of gastric erosions are asymptomatic.

All 22 cases of gastric erosion could be detected by routine gastroscopy, and the vast majority (87%) were discovered within 24 months after the procedure.

Patients with bandage erosion may experience symptoms.

Symptoms typically range from mild gastrointestinal discomfort to recurrent or chronic infections at the injection site or the presence of sinus tracts.

Common manifestations include reflux in asymptomatic patients or sudden changes in food intake.

This is due to the implanted bandage entering the stomach cavity and the thickening of the gastric mucosa, or due to gastric acid damaging the air-filled portion of the bandage.

Another possibility is that symptoms appear several months after surgery, such as an abscess forming at the injection site or a recurrent or chronic infection.

This does not appear to be a common triggering factor.

Infections occurring in this situation are usually resistant to antibiotics and topical treatment.

When these symptoms occur, an upper gastrointestinal endoscopy is necessary.

To see the implant penetrate into the lumen, a posteriorly flexible endoscope is often needed to observe the gastric fundus and gastric pleiotropy.

The bandage often penetrates from the stomach wall to the stomach wall, with the outer edge usually penetrating the stomach floor first.

The treatment for erosion is to remove the bandage.

The surgery was optional, and the patient received prophylactic antibiotics before the procedure.

During the operation, severe peritoneal reaction, adhesions, fragile tissues, and abscess formation may be found.

The technical method involves locating the strap through a water-filled connecting pipe and cutting the strap at the buckle with scissors or an ultrasonic scalpel.

It is usually unnecessary to open the stomach wall surrounding the stomach, as this would increase the operation time and the risk of stomach perforation.

After closing the breach, perform hydrostatic testing to prevent leakage.

Some reports suggest replacing the bandages at the same time, but this is not widely recommended.

When removing the bandage, the texture of the stomach tissue is often not suitable for changing the bandage, but an individualized assessment is required.

Endoscopic removal has also been reported, but it is only feasible when more of the bandage penetrates into the stomach cavity.

This requires special endoscopic equipment to cut the bandage and remove it from the mouth.

The erosion rate reported by the second author in this chapter further verifies the data.

A re-analysis of the first surgical video revealed that all patients generally had their bandages or buckles sutured under tension.

After that, our technique changed drastically. We no longer sew at the lock, and we ensured that there was no tension during the sewing process.

After these improvements were made, no erosion occurred in the subsequent 400 patients.

Problem with the water pump

Implanting the water pump for adjustable bandage surgery in the subcutaneous tissue is itself a cause of complications.

Local hematoma or seroma may appear immediately after surgery and can be treated conservatively.

The most common complications associated with water injection pumps are infection and leaks or breaks in the water injection connection pipe.

The reported complication rate of subcutaneous water pump is 4.5%–11%.

In our initial 600 patients, we reported an incidence of less than 1% of water inlet connection tube breakage or leakage.

These leaks are due to aging of the tapered connector (early models) or failure to puncture with a needle during adjustment.

All of these conditions require repair or replacement under local anesthesia.

It is important to emphasize that a special puncture needle, such as a Huber needle, must be used when making adjustments.

The high-pressure silicone septum can withstand 1000 punctures.

The product packaging also includes a repair kit, which contains spare water inlet hoses and metal connectors.

There is also a type of infusion pump that can tolerate fewer punctures, which is usually used when some weight has been lost and there is not much fascial and vascular protection.

The subcutaneous infusion pump may shift, but this can be detected during adjustment.

Some dislocations can be manually repositioned and fixed, and the bandages can be adjusted by injecting water into the water pump. Other bandage dislocations may require radiological examination for localization and a minor surgery to reposition and fix the water pump in the ideal position.

We recommend following the advice below to avoid this problem.

The water pump should be connected to the end of the water injection pipe, and the water injection pipe should not be bent at an angle.

The subcutaneous pump should be sutured to the fascia with non-absorbable sutures, and it is best to fix it to the anterior sheath of the rectus abdominis muscle.

Some surgeons chose the location below the sternum or xiphoid process.

Once in place, any excess tubing should be returned directly to the abdominal cavity. This prevents the tubing from affecting the wound in the early postoperative period and from being punctured by the needle during fluid adjustment.

A bend in the water inlet pipe can cause a valve effect, which is rare but can be a surgical emergency if it does occur.

This is usually discovered during injection conditioning; saline solution can be injected but cannot be withdrawn.

Because saline solution accumulates inside the bandage, patients may experience pain of varying degrees.

At this point, immediate bandaging and decompression are necessary. This can be achieved through local infiltration anesthesia, adjusting the infusion tubing near the wound to alleviate the valve effect, and aspirating some of the fluid.