Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation
We report an unusual complication after Lap-Band placement characterized by herniation of the anterior stomach through the band. Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patie...
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| Veröffentlicht in: | Obesity surgery 2005-02, Vol.15 (2), p.207-215 |
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| creator | Srikanth, Myur S Oh, Ki H Keskey, Thomas Rumbaut, Roberto Fox, S Ross Fox, Earl R Fox, Katherine M |
| description | We report an unusual complication after Lap-Band placement characterized by herniation of the anterior stomach through the band.
Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patients: Operated by us since August 2001 using the pars flaccida approach only. 4 patients with this unusual problem were identified.
Patients were all female, with age 37.5 (3343) yr, weight 143.7 (123-167) kg, and BMI 54 (45-65). Onset occurred at 9 (5-16) months, with weight loss: 38.5 (27-53) kg and %EWL 47.3 (31-54)%. All had sudden nausea, vomiting and epigastric abdominal pain that persisted despite emptying the band. None of these symptoms were related to a recent band adjustment. CT scan showed a paragastric Richter's hernia of the stomach underneath the band. At exploration, the band was in the normal location. 3 patients from Group 2 had Richter's hernia of the anterior stomach through the band; reduction of the stomach with closure of the defect was performed. One patient from group 1 had gangrene of the entrapped stomach, resulting in band removal and gastrectomy.
Lap-Band patients with sudden nausea, vomiting and abdominal pain, when not relieved by emptying the band, should undergo a CT scan. If a traditional slippage is not confirmed, paragastric Richter's hernia of the stomach through the band should be suspected. Immediate exploration with reduction of the stomach and closure of the defect can salvage the stomach and the band. Gastro-gastric sutures must completely close the space underneath the band to prevent this complication. |
| doi_str_mv | 10.1381/0960892053268471 |
| format | Article |
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Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patients: Operated by us since August 2001 using the pars flaccida approach only. 4 patients with this unusual problem were identified.
Patients were all female, with age 37.5 (3343) yr, weight 143.7 (123-167) kg, and BMI 54 (45-65). Onset occurred at 9 (5-16) months, with weight loss: 38.5 (27-53) kg and %EWL 47.3 (31-54)%. All had sudden nausea, vomiting and epigastric abdominal pain that persisted despite emptying the band. None of these symptoms were related to a recent band adjustment. CT scan showed a paragastric Richter's hernia of the stomach underneath the band. At exploration, the band was in the normal location. 3 patients from Group 2 had Richter's hernia of the anterior stomach through the band; reduction of the stomach with closure of the defect was performed. One patient from group 1 had gangrene of the entrapped stomach, resulting in band removal and gastrectomy.
Lap-Band patients with sudden nausea, vomiting and abdominal pain, when not relieved by emptying the band, should undergo a CT scan. If a traditional slippage is not confirmed, paragastric Richter's hernia of the stomach through the band should be suspected. Immediate exploration with reduction of the stomach and closure of the defect can salvage the stomach and the band. Gastro-gastric sutures must completely close the space underneath the band to prevent this complication.</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1381/0960892053268471</identifier><identifier>PMID: 15802063</identifier><language>eng</language><publisher>United States: Springer Nature B.V</publisher><subject>Adult ; Body Mass Index ; Cohort Studies ; Early Diagnosis ; FDA approval ; Female ; Follow-Up Studies ; Gastric Outlet Obstruction - epidemiology ; Gastric Outlet Obstruction - etiology ; Gastric Outlet Obstruction - surgery ; Gastroplasty - adverse effects ; Gastroplasty - methods ; Hernia - epidemiology ; Hernia - etiology ; Herniorrhaphy ; Humans ; Incidence ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Obesity, Morbid - diagnosis ; Obesity, Morbid - surgery ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - prevention & control ; Primary Prevention - methods ; Reoperation ; Risk Assessment ; Tomography, X-Ray Computed</subject><ispartof>Obesity surgery, 2005-02, Vol.15 (2), p.207-215</ispartof><rights>Springer 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c324t-4724d77f8f06c27e7287e657c30c4b6df16d474a7f06aa59d4802f7be53492fa3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15802063$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Srikanth, Myur S</creatorcontrib><creatorcontrib>Oh, Ki H</creatorcontrib><creatorcontrib>Keskey, Thomas</creatorcontrib><creatorcontrib>Rumbaut, Roberto</creatorcontrib><creatorcontrib>Fox, S Ross</creatorcontrib><creatorcontrib>Fox, Earl R</creatorcontrib><creatorcontrib>Fox, Katherine M</creatorcontrib><title>Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation</title><title>Obesity surgery</title><addtitle>Obes Surg</addtitle><description>We report an unusual complication after Lap-Band placement characterized by herniation of the anterior stomach through the band.
Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patients: Operated by us since August 2001 using the pars flaccida approach only. 4 patients with this unusual problem were identified.
Patients were all female, with age 37.5 (3343) yr, weight 143.7 (123-167) kg, and BMI 54 (45-65). Onset occurred at 9 (5-16) months, with weight loss: 38.5 (27-53) kg and %EWL 47.3 (31-54)%. All had sudden nausea, vomiting and epigastric abdominal pain that persisted despite emptying the band. None of these symptoms were related to a recent band adjustment. CT scan showed a paragastric Richter's hernia of the stomach underneath the band. At exploration, the band was in the normal location. 3 patients from Group 2 had Richter's hernia of the anterior stomach through the band; reduction of the stomach with closure of the defect was performed. One patient from group 1 had gangrene of the entrapped stomach, resulting in band removal and gastrectomy.
Lap-Band patients with sudden nausea, vomiting and abdominal pain, when not relieved by emptying the band, should undergo a CT scan. If a traditional slippage is not confirmed, paragastric Richter's hernia of the stomach through the band should be suspected. Immediate exploration with reduction of the stomach and closure of the defect can salvage the stomach and the band. Gastro-gastric sutures must completely close the space underneath the band to prevent this complication.</description><subject>Adult</subject><subject>Body Mass Index</subject><subject>Cohort Studies</subject><subject>Early Diagnosis</subject><subject>FDA approval</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastric Outlet Obstruction - epidemiology</subject><subject>Gastric Outlet Obstruction - etiology</subject><subject>Gastric Outlet Obstruction - surgery</subject><subject>Gastroplasty - adverse effects</subject><subject>Gastroplasty - methods</subject><subject>Hernia - epidemiology</subject><subject>Hernia - etiology</subject><subject>Herniorrhaphy</subject><subject>Humans</subject><subject>Incidence</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Obesity, Morbid - diagnosis</subject><subject>Obesity, Morbid - surgery</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - prevention & control</subject><subject>Primary Prevention - methods</subject><subject>Reoperation</subject><subject>Risk Assessment</subject><subject>Tomography, X-Ray Computed</subject><issn>0960-8923</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdUU2LFDEQDaK44-rdkwQP6h5a89VJxpsMugoLgui5qU5X92ToTtqkW3Z_2v47M-4swl6qKN4Hj3qEvOTsPZeWf2BbzexWsFoKbZXhj8iGG2YrpoR9TDZHuCq4PCPPcj4wJrgW4ik547Vlgmm5Ibe75BfvYKR4vSSckEJYMPmYaB79PMOA9N0MCQbIS_KO_vBuXwhvM91jCh4uaOzpskealziB21PoC0xHKKKYXZyLBrrDmhdoR6T3Ni2EzofhI0VI4w1N6OIQSpIYSoCOzgn_YPh3Fvt7UZkQhnWEI_CcPOlhzPjitM_Jry-ff-6-VlffL7_tPl1VTgq1VMoI1RnT255pJwwaYQ3q2jjJnGp113PdKaPAFByg3naqvKY3LdZSbUUP8py8ufOdU_y9Yl6ayWeH4wgB45obbWptmdaF-PoB8RDXFEq2xgrOmdTsSGJ3JFe-kxP2zZz8BOmm4aw5dto87LRIXp1813bC7r_gVKL8CzDNoCA</recordid><startdate>200502</startdate><enddate>200502</enddate><creator>Srikanth, Myur S</creator><creator>Oh, Ki H</creator><creator>Keskey, Thomas</creator><creator>Rumbaut, Roberto</creator><creator>Fox, S Ross</creator><creator>Fox, Earl R</creator><creator>Fox, Katherine M</creator><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200502</creationdate><title>Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation</title><author>Srikanth, Myur S ; Oh, Ki H ; Keskey, Thomas ; Rumbaut, Roberto ; Fox, S Ross ; Fox, Earl R ; Fox, Katherine M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-4724d77f8f06c27e7287e657c30c4b6df16d474a7f06aa59d4802f7be53492fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Body Mass Index</topic><topic>Cohort Studies</topic><topic>Early Diagnosis</topic><topic>FDA approval</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastric Outlet Obstruction - epidemiology</topic><topic>Gastric Outlet Obstruction - etiology</topic><topic>Gastric Outlet Obstruction - surgery</topic><topic>Gastroplasty - adverse effects</topic><topic>Gastroplasty - methods</topic><topic>Hernia - epidemiology</topic><topic>Hernia - etiology</topic><topic>Herniorrhaphy</topic><topic>Humans</topic><topic>Incidence</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Obesity, Morbid - diagnosis</topic><topic>Obesity, Morbid - surgery</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - prevention & control</topic><topic>Primary Prevention - methods</topic><topic>Reoperation</topic><topic>Risk Assessment</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Srikanth, Myur S</creatorcontrib><creatorcontrib>Oh, Ki H</creatorcontrib><creatorcontrib>Keskey, Thomas</creatorcontrib><creatorcontrib>Rumbaut, Roberto</creatorcontrib><creatorcontrib>Fox, S Ross</creatorcontrib><creatorcontrib>Fox, Earl R</creatorcontrib><creatorcontrib>Fox, Katherine M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Srikanth, Myur S</au><au>Oh, Ki H</au><au>Keskey, Thomas</au><au>Rumbaut, Roberto</au><au>Fox, S Ross</au><au>Fox, Earl R</au><au>Fox, Katherine M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation</atitle><jtitle>Obesity surgery</jtitle><addtitle>Obes Surg</addtitle><date>2005-02</date><risdate>2005</risdate><volume>15</volume><issue>2</issue><spage>207</spage><epage>215</epage><pages>207-215</pages><issn>0960-8923</issn><eissn>1708-0428</eissn><abstract>We report an unusual complication after Lap-Band placement characterized by herniation of the anterior stomach through the band.
Group 1 - 105 patients: Operated elsewhere (prior to US FDA approval) and followed by us; perigastric technique was used in 74 and pars flaccida in 31. Group 2 - 218 patients: Operated by us since August 2001 using the pars flaccida approach only. 4 patients with this unusual problem were identified.
Patients were all female, with age 37.5 (3343) yr, weight 143.7 (123-167) kg, and BMI 54 (45-65). Onset occurred at 9 (5-16) months, with weight loss: 38.5 (27-53) kg and %EWL 47.3 (31-54)%. All had sudden nausea, vomiting and epigastric abdominal pain that persisted despite emptying the band. None of these symptoms were related to a recent band adjustment. CT scan showed a paragastric Richter's hernia of the stomach underneath the band. At exploration, the band was in the normal location. 3 patients from Group 2 had Richter's hernia of the anterior stomach through the band; reduction of the stomach with closure of the defect was performed. One patient from group 1 had gangrene of the entrapped stomach, resulting in band removal and gastrectomy.
Lap-Band patients with sudden nausea, vomiting and abdominal pain, when not relieved by emptying the band, should undergo a CT scan. If a traditional slippage is not confirmed, paragastric Richter's hernia of the stomach through the band should be suspected. Immediate exploration with reduction of the stomach and closure of the defect can salvage the stomach and the band. Gastro-gastric sutures must completely close the space underneath the band to prevent this complication.</abstract><cop>United States</cop><pub>Springer Nature B.V</pub><pmid>15802063</pmid><doi>10.1381/0960892053268471</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Body Mass Index Cohort Studies Early Diagnosis FDA approval Female Follow-Up Studies Gastric Outlet Obstruction - epidemiology Gastric Outlet Obstruction - etiology Gastric Outlet Obstruction - surgery Gastroplasty - adverse effects Gastroplasty - methods Hernia - epidemiology Hernia - etiology Herniorrhaphy Humans Incidence Laparoscopy - adverse effects Laparoscopy - methods Obesity, Morbid - diagnosis Obesity, Morbid - surgery Postoperative Complications - diagnostic imaging Postoperative Complications - prevention & control Primary Prevention - methods Reoperation Risk Assessment Tomography, X-Ray Computed |
| title | Critical extreme anterior slippage (paragastric Richter's hernia) of the stomach after laparoscopic adjustable gastric banding: early recognition and prevention of gastric strangulation |
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