Luminal GIT

Stomach & Small Intestine

Esophagus

GI Bleed [Speed Live]

Peritoneum & Mesentery

ABDOMINAL VASCULAR INJURY

Colon & Rectum

The Appendix

Acute Abdomen

Hernias

Abdominal Wall, Mesentery, Peritoneum & Retroperitoneal Disorders

Neuroendocrine Neoplasms (NENs)

Prolapse Following Laparoscopic Adjustable Gastric Banding (LAGB)

Clinical Presentation

• Prolapse occurs when the stomach herniates through the band, leading to partial or complete obstruction.
• Symptoms include acute epigastric pain, dysphagia, and in severe cases, potential gastric ischemia or gangrene.
• On X-ray, the band appears in a horizontal position, diagnostic of prolapse.

Diagnosis

• Plain abdominal X-ray: Band normally positioned from 7 o'clock to 1 o'clock, but prolapse flattens it to a horizontal orientation.
• If uncertain, a low-volume Gastrografin or barium swallow can confirm the diagnosis by showing the position of the herniated stomach.

Initial Management

• Remove fluid from the band: This often allows the prolapsed stomach to return to its normal position.

Next Steps

• If symptoms persist despite fluid removal, a swallow study is performed to assess the extent of the prolapse.
• If the prolapse is large and persistent, emergent laparoscopic surgery is required.

Surgical Management

• Laparoscopy to:
  • Unbuckle the band.
  • Reduce the prolapse.
  • Reposition and rebuckle the band.