Background

Laparoscopic adjustable banding procedure (LABP), a once popular bariatric procedure, has fallen out of favor due to inferior weight loss and frequent band, tube, and port-related complications. Due to weight loss failure, 20-30% are converted to gastric bypass or sleeve gastrectomy. We present an unusual case of a 41-year-old woman who developed food intolerance and recurrent partial small bowel obstructions (pSBO) 10 years after LABP. Fluoroscopic and endoscopic assessment revealed esophageal dilatation and esophagitis, and her symptoms failed to improve after band emptying. CT revealed terminal ileal obstruction attributed to the tubing.

Methods

We show the tubing and adhesions constricting the terminal ileum 15 cm proximal to the ileocecal valve causing pSBO. Adhesions were lysed and the bowel freed after division of the tube and removal of the gastric band. Concurrent endoscopy revealed neither erosion nor leak. She was discharged after 1 night of observation.

Results

LABP has recently fallen out of favor with the concurrent rise in popularity of the laparoscopic sleeve gastrectomy (LSG). Complications associated with the subcutaneous port or band itself are well-known, but morbidity related to the tubing is not. Rarely described are SBOs caused by tubing via formation of an internal hernia. These have occurred up to 10 years following LABP, and the majority of these cases noted redundancy in the tubing as the likely cause.

Conclusions

Our case illustrates that intermittent pSBO in patients with LABP requires early CT evaluation and bariatric surgery consultation followed by laparoscopic intervention to avoid serious complications.