Currently, vertical banded gastroplasty is one of the procedures of choice for the
treatment of morbid obesity [1]
[2]. It is a restrictive technique, associated with a rapid weight loss that is fairly
well maintained over time. However, the price paid for these results is relatively
high, if complications and the additional surgical procedures needed to resolve them
are considered.
A 34-year-old woman, who 4 months previously had undergone vertical banded gastroplasty
for the treatment of morbid obesity, was admitted to our hospital, complaining of
epigastric pain during the last 5 days and “coffee-ground” vomiting in the previous
24 hours. Laboratory findings revealed mild leukocytosis and iron-deficiency anemia,
while the radiographic examination showed no gastric dilatation or pneumoperitoneum.
Upper endoscopy revealed one of the most unusual complications of vertical banded
gastroplasty: migration of the band. The silastic band was located just below the
cardia, along the lesser curvature in the upper third of the stomach, and it was removed
using rat-tooth forceps (Figures [1]
[2]
[3]). The successful endoscopic attempt to overcome this complication avoided a surgical
intervention. A control endoscopy 2 weeks later revealed ulceration of the area, and
the patient was completely well at a 3-month follow-up.
Figure 1 Upper endoscopy showed migration of the silastic band, one of the most unusual complications
of vertical banded gastroplasty.
Figure 2 With retroflexion, the silastic band could be seen just below the cardia.
Figure 3 The silastic band was removed using rat-tooth forceps.
Complications encountered during follow-up after vertical banded gastroplasty [2]
[3], include stenosis (20 %), staple-line disruption (11 %), incisional hernia (13 %),
severe esophagitis (7 %), and band migration (1.5 %). The majority of these patients
require one or more corrective procedures, including re-operation [4]. These complications should be borne in mind with regard to patients who have undergone
this technique for the treatment of morbid obesity.
