A Lap-Band slip means part of the stomach has pushed up through the band, so the pouch above it gets bigger and the band sits at the wrong angle. Typical signs are new vomiting, food that will not go down, heartburn and pain. It is confirmed with an upper GI X-ray. Treatment starts with removing fluid from the band; some slips then need surgery.
What a slipped band is
The band is meant to sit high on the stomach, leaving a small pouch above it. In a slip, stomach tissue below the band moves up through it. The FDA's Summary of Safety and Effectiveness Data for the Lap-Band explains that "band slippage refers to slippage of the stomach up through the band rather than slippage of the band down lower on the stomach," and that it most often involves the back wall of the stomach.
A slip is related to, but not the same as, pouch dilation (an evenly stretched pouch above a band that has not moved). The two can cause the same symptoms. In the original U.S. trial that led to FDA approval, they were counted together and reported in 24% of the 299 people enrolled over three years. That trial was run at centres with limited band experience, and the FDA summary notes higher complication rates than in published series from more experienced surgeons. A review in the Canadian Journal of Surgery (Eid and colleagues, 2011) cites reported slip rates from 1% to 22% across the literature.
Symptoms of Lap-Band slippage
According to the Eid review, people usually notice:
- Trouble swallowing (dysphagia), with food stopping high in the chest
- Vomiting or bringing food back up (regurgitation)
- Not tolerating foods that used to go down easily
- New or worse heartburn, often at night
- Pain in the upper abdomen
A review in the Annals of the Royal College of Surgeons of England (Monkhouse and colleagues, 2009) notes that a bout of heavy vomiting often comes before an acute slip. It also warns that pain may be mild even when the trapped stomach is losing its blood supply. Mild pain does not rule out a serious problem.
How a slip is diagnosed
The standard test is an upper GI series, also called a barium swallow. You drink a contrast liquid while X-ray pictures show the band, the pouch and how liquid flows through. The Monkhouse review calls a two-view barium swallow "the investigation of choice." Even a plain X-ray can show a band lying flat or at an odd angle instead of its normal diagonal position.
Radiologists look at specific signs. In a 2014 study in the American Journal of Roentgenology, an air-fluid level above the band and a band sitting more than 2.4 cm below the diaphragm were both highly accurate for a slip. The older "phi angle" measurement picked up most slips but also flagged many normal bands. For more on each test, see tests for Lap-Band problems.
What is done about it
Removing fluid first
When a slip is suspected, the band is usually emptied straight away through the port under the skin. Monkhouse and colleagues write that "emergency management necessitates immediate band deflation." Taking the pressure off can let the stomach settle and blood flow return. In the FDA trial, about half of resolved slip or pouch-dilation events (52%) settled with an adjustment or no treatment.
Surgery when deflation is not enough
If symptoms do not ease quickly, or the X-ray shows a true slip, an operation is needed. Monkhouse and colleagues state that re-operation is then necessary "to avoid the risk of gastric ischaemia," meaning loss of blood supply to the stomach. The Eid review names laparoscopic (keyhole) repositioning or removal of the band as the preferred treatment. In the FDA trial, 48% of resolved events needed surgery to revise, replace or remove the device.
Whether to reposition the band, remove it, or convert to another operation depends on your symptoms, weight history and the surgeon's findings. Our Lap-Band revision page explains those choices.
When to call
Go to an emergency room or call 911 if
- You cannot keep down water or even your own saliva
- You have severe or worsening pain in the abdomen or chest
- You are vomiting blood or material that looks like coffee grounds
- You feel faint, have a racing heart, or are passing very little urine
Tell the staff you have an adjustable gastric band. The full list is on our emergency warning signs page.
Call the office the same day if
- Food sticks or comes back up at most meals, but liquids still go down
- Heartburn or a night-time cough is new or getting worse
- You can suddenly eat much less than you could a week ago
Frequently asked questions
Can a slipped Lap-Band go back into place on its own?
Sometimes the symptoms settle after the band is emptied, especially with pouch dilation. An American Family Physician review (Kodner and Hartman, 2014) says deflation and stricter eating habits should bring the pouch back to normal size in four to six weeks. A true slip that does not respond to deflation is treated surgically. A repeat X-ray shows which situation you are in.
Did I cause my band to slip?
Not necessarily. Slips also relate to how and where the band was placed. Kodner and Hartman note that slippage happens more often with overeating, and a 2008 Obesity Surgery study (Brown and colleagues) links pouch enlargement to eating too fast, eating too much, or a band that is too tight. Small, slow meals and avoiding over-tight fills lower the pressure on the pouch.
If my slipped band is fixed, can I keep it?
Sometimes. The Eid review lists repositioning as well as removal as accepted treatments, and the FDA trial included both. Whether repositioning is sensible depends on how the band worked for you before, the condition of the stomach and your goals. Some people choose removal or a conversion instead.
Can a slip happen many years after the band was placed?
Yes. Slips are described as late complications, meaning they can appear long after the first month. People who have had a band for ten years or more can still develop one. New swallowing trouble or vomiting in a long-standing band is worth an X-ray, not just a fill change.
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, and he sees band patients 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 use our contact page. The first consultation is complimentary, and Hablamos Español. You can read more in our Rancho Cucamonga Lap-Band guide.
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
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Getting care in Rancho Cucamonga
