Go to an emergency room or call 911 if you cannot keep down water or saliva, vomit blood, pass black stools, have severe or worsening pain in the chest or abdomen, or have a fever with spreading redness at the port. These can mean a blocked or slipped band, bleeding, or infection. Frequent food sticking, new reflux or fading restriction need a call to your surgeon instead.
Why some band symptoms cannot wait
Most Lap-Band problems develop slowly and can be handled in the office. A few cannot. A review in the Annals of the Royal College of Surgeons of England (Monkhouse and colleagues, 2009) explains that a slipped band can completely block the stomach outlet. If pressure is not relieved quickly, part of the stomach can lose its blood supply (ischemia). The authors warn that "pain may be minimal even in cases of incipient gastric ischaemia," so a fast heart rate or feeling very unwell can matter as much as pain.
A complete blockage also stops you from drinking. In the FDA trial behind the device's approval, the signs reported with a blocked band opening included vomiting, dehydration and low potassium. That is why being unable to keep liquids down is treated as urgent, even if you otherwise feel well.
When to call 911 or go to an emergency room
| Symptom | What it can mean |
|---|
| Cannot keep down water, or bringing back your own saliva | The band opening is blocked by swelling, food, a slip or an over-tight fill. Dehydration follows quickly. |
| Severe or worsening abdominal pain, especially with vomiting | Slipped band with trapped stomach, perforation or another emergency |
| Chest pain, shortness of breath, sweating, pain spreading to arm or jaw | Could be the band or esophagus, but could be the heart. Call 911. |
| Vomiting blood or material like coffee grounds, or black, tarry stools | Bleeding, which can come from an ulcer or band erosion |
| Fever and chills with redness spreading from the port, or feeling very ill | Infection, which late after surgery can be linked to erosion |
| Fast heartbeat, dizziness, fainting or very little urine | Dehydration or a serious internal problem |
The American Family Physician review by Kodner and Hartman (2014) lists vomiting blood, fever and sepsis (a body-wide reaction to infection) among the signs of band erosion. The Eid review in the Canadian Journal of Surgery notes that late port infections are often caused by erosion. More detail is on our Lap-Band erosion and Lap-Band slippage pages.
When to call the office the same day
These symptoms are not usually emergencies, but they should not wait for your next routine visit:
- Food sticks or comes back up at most meals, while liquids still pass
- New or worse heartburn, or a cough that wakes you at night
- Foamy saliva coming back up most days
- Redness, warmth or drainage at the port site without fever
- You can suddenly eat much less, or much more, than a week ago
- Swallowing problems that started after a recent fill
The FDA labeling says that after a fill, a physician familiar with adjustments should be available for several days to remove fluid if the opening becomes blocked. If you cannot swallow after a fill, do not wait it out. Our trouble swallowing page explains the causes.
When to book a routine visit
Slow weight regain, more hunger between meals, or fills that no longer seem to last are worth a planned appointment. They are not emergencies, but they can be early signs of a leak, a stretched pouch or an erosion. See weight regain with a Lap-Band.
What to tell emergency staff
Emergency staff will not know your band history unless you tell them. Tell them clearly:
- You have an adjustable gastric band (Lap-Band), when it was placed and who placed it
- How much fluid is in it, if you know, and the date of your last fill
- Your surgeon's name and phone number, so they can call
Monkhouse and colleagues state that when a slipped band is suspected, "emergency management necessitates immediate band deflation," done while tests are arranged. The FDA labeling specifies that the port should only be entered with the dedicated access port needles, because ordinary hypodermic needles may cause leaks. The NIDDK also notes that gastric bands "can move out of position or erode into the stomach wall and need to be removed," so emergency staff may call a surgeon.
Frequently asked questions
Should I go to urgent care or an emergency room for a band problem?
For the emergency symptoms above, go to an emergency room. A blocked or slipped band may need X-rays, blood tests and a surgeon's review quickly, and an emergency department is set up to arrange them. For anything less serious, call the surgeon's office first and ask where to be seen.
Will I need surgery if I go to the ER with a band problem?
Not always. Monkhouse and colleagues describe removing fluid from the band as the first emergency step for a suspected slip; if that quickly relieves the symptoms, surgery may not be needed straight away. If it does not, they state that re-operation is necessary to protect the stomach's blood supply. Bleeding or infection from an erosion leads to band removal.
What details about my band should I keep on my phone or in my wallet?
Keep the band brand and model if you know it, the date and place of surgery, your surgeon's name and number, how much fluid is in it and your last fill date. If your band was placed years ago by a surgeon you no longer see, ask your current band surgeon to help you put this together.
Is vomiting once after a meal an emergency?
Usually not, if it happened after eating too fast or too much and you can drink normally afterwards. It becomes urgent if you cannot keep water or saliva down, vomit blood, or have severe pain. Vomiting after most meals is not an emergency, but call the office, because it can be a sign of a tight band or a slip.
Talk with Dr. Davtyan in Rancho Cucamonga
Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon who has a Lap-Band himself. For non-emergency band problems, call the Rancho Cucamonga office at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730, on 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use the contact page. The first consultation is complimentary and Hablamos Español; see the Rancho Cucamonga Lap-Band guide for more.
Sources
More in the Lap-Band in Rancho Cucamonga guide
Start at the Lap-Band in Rancho Cucamonga page, or go straight to a topic.
Understanding your band
Weighing your options
Getting care in Rancho Cucamonga
