Nov - Dec 2012

Doctor, Has My Band Slipped?

By Robert E. Alleyn, MD FACS


Most bariatric surgery patients are very well educated regarding possible complications because bariatric programs inform patients prior to surgery and in addition, most patients have done their own research. This knowledge is appropriate and useful, but it sometimes leads to unnecessary anxiety. We sometimes have patients come to the clinic worried that their band may have slipped even though they are clinically doing well.  It is unlikely that a patient will have a slipped band without recognizable symptoms.  In this article I will discuss what the term “slipped band” means, why it happens, and how it is repaired.

 

There are different ways that a band may "slip."  The most common form of band slippage in the United States is the anterior slip (anterior means the front).  This is a misnomer because the technique frequently used to place the band fixes it posteriorly (on the backside of the stomach).  When a patient has an anterior slip, the band essentially stays in the same place while the front part of the stomach slides up through the band.  This causes at least some degree of obstruction.

 

The band usually slips because of overeating and vomiting.  Typically the patient has a history of doing well with a fairly sudden onset of digestive symptoms.  The most common symptoms are reflux and obstruction like vomiting after eating only a small amount of food.  In severe cases, the patients may not even be able to keep down their saliva.  During these events, the patient may or may not experience pain.  If these symptoms occur shortly after a fill, then the band probably has not slipped, but instead might be too tight which requires removal of some of the saline.

 

The diagnosis of a slipped band is usually pretty straightforward.  The patient's history is often very suggestive of a slipped band.  A barium swallow x-ray is used to confirm the diagnosis.  We do not routinely use endoscopy to diagnose a slipped band but sometimes it is used to exclude other problems.  The slip is readily seen at the time of endoscopy.

 

A slipped band requires surgical correction.  If the patient has been satisfied with the band up to that point, the stomach is repositioned and then again secured with sutures in a way that will help prevent further slippage.  If the patient has not been satisfied with the band, we can remove the band and convert to another type of bariatric procedure, most commonly a sleeve gastrectomy. If the band has slipped more than once, we strongly encourage the patient to consider one of the other weight loss surgeries because the band will likely slip again.  We rarely have a patient who simply wants the band out after a slip without opting for a second weight loss procedure.  We do not encourage removal of the bands without a conversion to another bariatric procedure because the patient will almost certainly regain their weight.