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Slippage


tylove
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:mellow: Hey yall! My girlfriend was banded yesterday and we are on our way home tomorrow. I just had a quick question, how do you know if your band slips? This is our main concern. What causes it to slip? Today she only had water, diluted juice and broth. She has been feeling gassy all day. And her stomach is a little sore where the big incision is and she also feels pressure... Is this normal the day after surgery?
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This is absolutely normal. This is major surgery and the gas pressure can get very painful. I will never take a belch for granted again. Her port is going to be sore since they stitch it into the abdominal muscle. It is going to be a few weeks till she feels normal again.

I do not know the exact symptoms of a slippage, but i do know what it feels like to get out of surgery.

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What is a slipped Band, and what causes it?

There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation, but this is not the same as slippage. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band.

There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem.

Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently.

How is a slipped Band diagnosed?

Fortunately, this is very easy. Often the diagnosis is made based on the history alone. A patient who has been going along fine, with no problems, and then suddenly develops reflux symptoms or symptoms of a too-tight Band will most likely have a slipped Band. The diagnosis is easily confirmed with an x-ray and barium swallow examination. Endoscopy is rarely necessary.

How is a slipped Band fixed?

A slipped Band needs to be fixed with an operation. The Band has to be dissected out, all the sutures removed, and the position of the stomach made right. Some surgeons remove the Band and place it back through a new tunnel. Others just straighten things out and re-suture the stomach over the Band.

What happens if the Band slips again?

That's a tough one. One could certainly try to fix the slip again, but my personal view is that, for whatever reason, the Band is just not working for that particular patient, and ought to be removed.

What is a Band erosion?

This is when the Band actually erodes into the stomach. It is a more serious problem, and generally requires removal of the Band. Band erosion is thought to be related to placing too many sutures (or too tight sutures) at the time of Band implantation. Surprisingly, Band erosion is often unnoticed. Occasionally the port will become infected if bacteria track along the catheter out to the port. Other times patients will stop losing weight. Diagnosis often requires an endoscopy.

What is concentric pouch dilation?

This is technically not the same as slippage. In this case the pouch just seems to be enlarged. Sometimes partial emptying of the Band may help with this.

What is esophageal dilation?

This is when the esophagus enlarges over time, and is probably related to either too tight a Band, or possibly improper placement of the Band around the junction of the esophagus and stomach. This requires loosening or removal of the Band.

What happens if my Band has to be removed because of complications or failure to lose weight?

One option, of course, is to give up on weight loss surgery. Another option is to convert to another procedure such as Roux-en-Y gastric bypass. This can be done at the same time the Band is removed, and is generally done laparoscopically.

__________________

Mild slip: Deflate the band, reinflate in one to two weeks

Moderate slip: Deflate the band, operate to reposition band

Severe slip: Deflate band and operate to remove band

Jann

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