Lap-Band Erosion: Signs, Why It Happens and Treatment

Lap-Band Erosion: Signs, Why It Happens and Treatment

Lap-Band erosion means the band has slowly worn through the stomach wall, so part of it now sits inside the stomach. It is uncommon. The most frequent clue is losing restriction no matter how much fluid is added; some people have pain, bleeding or a port infection, and some have no symptoms at all. It is confirmed by endoscopy and treated by removing the band.

What erosion is and how often it happens

The band is supposed to sit on the outside of the stomach. In an erosion it works its way through the stomach wall into the inside (the lumen).

A 2011 systematic review in Obesity Surgery (Egberts and colleagues) pooled 25 studies and found 231 erosions in 15,775 band patients, an overall rate of 1.46%. Rates varied widely between reports. In the original U.S. trial summarised by the FDA, 4 of 299 people (1%) had an erosion. Older techniques had higher rates. A Belgian study of bands placed in the mid-1990s and followed for 12 years or more (Himpens and colleagues, 2011) reported erosion in 28% of patients it could reach. That figure reflects early methods and is not typical of current practice.

Why a band erodes

The exact cause is not always clear, but several factors are described in the FDA labeling and the literature:

Injury to the stomach during surgery. The FDA summary warns that any damage to the stomach during placement may lead to later erosion. Two of the four erosions in the FDA trial were linked to a perforation during the operation.
How the band was placed. The FDA labeling says the band should not be sutured directly to the stomach, because this may cause erosion. In a Monash University series of almost 3,000 patients (Brown and colleagues, 2013), erosion was more common with an older "perigastric" placement than with the later "pars flaccida" approach.
Surgeon experience. The Egberts review found that erosion rates related to the number of patients treated and the surgeon's years of experience.
Anti-inflammatory medicines. The FDA labeling cautions that aspirin and non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and naproxen) "may be associated with an increased risk of erosion."
Previous surgery on the stomach. The FDA labeling notes that in revision procedures the risk of erosion and infection is increased.

Erosion can appear years after surgery. In the Brown series the median time was 33 months, with a range of 11 months to just over 14 years.

Signs of Lap-Band erosion

Many erosions are quiet. The Eid review in the Canadian Journal of Surgery states that most patients are asymptomatic. When there are symptoms, they include:

Loss of restriction. You can eat much more than before and fills make no difference. Brown and colleagues found this was the most common presentation.
Weight regain without a clear reason.
Pain in the upper abdomen that is new or will not settle.
A port-site infection appearing years after surgery. The Eid review notes that late port infections are often caused by erosion, with infection tracking up the tubing.
Bleeding, such as vomiting blood or black, tarry stools. An American Family Physician review (Kodner and Hartman, 2014) also lists fever and sepsis (a body-wide reaction to infection).

The FDA labeling adds a practical warning: when weight loss stalls because of pouch enlargement or erosion, adding more fluid to the band is not appropriate. That is one reason a long-standing band that has stopped working should be checked before it is simply tightened. Our weight regain with a Lap-Band page covers the other causes.

How erosion is diagnosed and treated

According to the Eid review and Kodner and Hartman, the diagnosis is usually made by upper endoscopy, where a thin camera is passed through the mouth into the stomach and the band can be seen inside it. An upper GI X-ray or a CT scan may suggest erosion, but endoscopy confirms it. See tests for Lap-Band problems for what each test involves. The office will confirm by phone where endoscopy is arranged for its patients.

An eroded band is removed. The Eid review recommends complete removal, usually laparoscopically (keyhole surgery), and the defect in the stomach is repaired. The Egberts review describes three paths after that: removal alone, removal with a new band placed later, or conversion to another operation such as a sleeve or bypass. In the Brown series, people who had a new band placed after healing lost about as much weight as other band patients. The Lap-Band revision page explains how these choices are weighed.

When to call

Go to an emergency room or call 911 if

You vomit blood or material that looks like coffee grounds
Your stools are black and tarry
You have severe abdominal pain, or fever with chills and feel very unwell

Call the office if

Fills no longer give you any restriction
The skin over your port is red, warm, swollen or draining, without fever
You have nagging upper-abdominal pain that keeps coming back

Frequently asked questions

Can I take ibuprofen or aspirin if I have a Lap-Band?

The FDA labeling advises that aspirin and NSAIDs such as ibuprofen and naproxen should be used with caution, because they may increase the risk of erosion. Ask your surgeon or primary care doctor before taking them regularly. If you need them for another condition, such as heart protection, do not stop on your own; ask your doctors to plan it together.

Is an eroded band an emergency?

Often it is not. Erosion usually develops slowly, and Brown and colleagues described its clinical course as benign in their series. It still needs prompt evaluation and removal. Bleeding, fever or severe pain change that, and those need emergency care straight away.

Can I get another band after an erosion?

Some people do. In the Monash series, a new band was placed after healing in 56 of 85 patients, and their weight loss was similar to other band patients. Others chose removal alone or conversion to a sleeve or bypass. Your history, the condition of your stomach and your goals guide the choice.

Does removing an eroded band leave a hole in my stomach?

The opening where the band passed into the stomach is dealt with during treatment. The Egberts review describes removal of the band with repair of the stomach as the most common approach, and the Eid review recommends complete removal of the band. Your surgeon will explain how the repair is planned and what the recovery involves.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon and a Lap-Band patient himself. His Rancho Cucamonga office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730; call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or reach us through the contact page. The first consultation is complimentary, Hablamos Español, and the Rancho Cucamonga Lap-Band guide covers related topics.

Lap-Band Erosion: Signs, Why It Happens and Treatment