Case report
Intracolonic tubing migration: an unusual complication of the silastic
adjustable gastric band (LapBand)
Brent J. Bell, M.D., Katherine M. Myers, C.S.T., Eric S. Bour, M.D.*
Department of Surgery, Greenville Hospital System, University Medical Center, Greenville, South Carolina
Received March 21, 2007; revised March 23, 2007; accepted March 29, 2007
Keywords: LapBand; LapBand complication; LapBand infection
Obesity is a condition of multifactorial etiology with
high personal and societal costs. In general, it has proved
refractory to medical management. For decades, surgical
procedures have been available for the treatment of obesity.
However, recently, their popularity has increased. One of
the currently favored restrictive techniques is the laparo-
scopic adjustable gastric band system in which an adjust-
able, inflatable band is placed around the gastric cardia,
creating a small proximal gastric pouch. Although the over-
all mortality and morbidity rates of the LapBand (Allergan
Inc, Santa Barbara, CA) are at least as low as other popular
techniques such as laparoscopic Roux-en-Y gastric bypass,
the band is a foreign body, making it susceptible to infection
and malfunction. Additional common complications re-
ported for the laparoscopic adjustable gastric banding sys-
tem include band slippage and herniation, band erosion,
mechanical malfunction, port migration, and port infection.
Case report
A 19-year-old woman with a history of morbid obesity
complicated by deep vein thrombosis and pulmonary em-
bolism underwent LapBand placement in July 2002. At
surgery, she weighed 278 lb and had a body mass index of
47 kg/m
2
. At 25 months postoperatively, she had experi-
enced 60% excess weight loss. She sought plastic surgical
consultation and underwent a belt lipectomy and abdomi-
noplasty. Following this procedure, her port became dis-
lodged inferiorly, requiring revision. The port subsequently
became infected, necessitating its removal. During this pro-
cedure, the tubing was removed from the port, occluded
with two titanium clips, and internalized into the abdominal
cavity.
The patient was seen for regular postoperative follow-up
examinations and was scheduled for port replacement 14
months later. At the procedure, she had no abdominal com-
plaints, but she had regained approximately 26 lb. During
the laparoscopic port replacement procedure, the free end of
the LapBand tubing could not be readily identified. Using
fluoroscopy, the tubing was visualized within the abdomen,
but the free end appeared to be located within the colon. The
laparoscopic approach was abandoned, and laparotomy was
performed. At laparotomy, the tubing was palpated within
the lumen of the transverse colon. A thick capsule sur-
rounded the tubing as it entered the lumen of the colon. The
capsule was opened, and the tubing was traced proximally
and distally. Exploration identified two separate areas where
the tubing traversed the colon before entering the transverse
colon and migrating intraluminally (Fig. 1). The tubing was
removed from the colon, and the affected areas of the colon
were repaired primarily. The tubing was followed proxi-
mally to the band, and the band was removed. Postopera-
tively, the patient has done relatively well; however, she has
regained an additional 20 lb.
Discussion
The laparoscopic adjustable gastric banding procedure is
a popular surgical treatment for morbid obesity, in part
because it is thought to have a better safety profile than
competing procedures [1]. Reviews evaluating the compli-
cations of this procedure have shown an overall complica-
tion rate of approximately 11%. The incidence of compli-
*Reprint requests: Eric S. Bour, M.D., F.A.C.S., 2104 Woodruff Road,
Greenville, SC 29607.
Surgery for Obesity and Related Diseases 3 (2007) 486 – 487
1550-7289/07/$ – see front matter © 2007 American Society for Bariatric Surgery. All rights reserved.
doi:10.1016/j.soard.2007.03.245