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Lap Band EROSION!!

What is really LAP BAND EROSION?

There are some terms that have become very familiar to us because they are commonly used among doctors and patients.
One example of a popular term is “Lap Band” which really stands for Laparoscopic Gastric Banding.

The term “Lap Band Erosion” also became very popular among the banded patients as the message boards increased in popularity. The patients that already had the Lap Band were scared because “erosion” was related to the need of being de-banded or having to lose the band. But what the term really means is that the stomach has gotten a penetrating ulcer and has eroded towards the balloon of the band.

Why the Lap Band Patient can have Stomach Erosion?

Intragastric band erosions have been reported at rates that vary from 3 to 10% depending of the operatory technique, device used and patient’s eating behavior.

There are several different and controversial theories:

  • The first theory that came out is that the Lap Band around the stomach gradually erodes into the stomach wall and goes into the gastric lumen as we have seen with other intrabdominal devices.
  • Other theory we frequently hear is the one of stomach damage done during Lap Band procedure which debilitates the layers of the stomach wall favoring the erosion in a later stage.
  • Another theory is that the sutures were placed to deep and trespassed all the wall layers of the stomach causing micro perforations that generate leaking, infection and later erosion.
  • The last theory and I believe the most consistent and important of them and also the most frequent seen in the vast majority of patients with “erosion” is that events that happens inside the stomach as frequent vomiting, medications, ingestion of irritants as spicy or hot food, alcohol, etc. plus a big adjustment to the band system will produce an ulcer that penetrates toward the balloon of the band.

There were other theories but never scientifically proven like that of a crease or a fold in the balloon would harm the stomach ending finally in the erosion of the stomach wall.

We have seen erosion with all kinds of Lap Bands and with all kinds of balloons and find no correlation with the fold theory.

Once the erosion-ulcer is established it is not possible to cure the ulcer, not even by removing all the fluid in the band. Therefore the need of removing the band itself turns imperative.

I recommend the band to be removed AS SOON AS POSSIBLE not because been an emergency in any way but because there is a risk of increasing the ulcer’s size.

Removing the Lap band avoids complications such as infection traveling along the hose to the port and to the skin, or stomach bleeding.

There are several ways to Prevent Erosion:

  • The first I personally recommend are to Avoid “Big Fills” to the Lap Band in order to prevent vomiting or gastric reflux.
  • The second I recommend is to protect the stomach with anti-acids frequently, specially at bed time.
  • The third recommendation is do not drink alcohol, hot or spicy food, vinegar, soy sauce, or coffee.
    Talk with your Doctor about the medications you are actually taking and change the ones that can hurt your stomach for others with the same effect but are not harmful to it.

Arturo Rodriguez, MD
Bariatric Surgeon

     

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