Little Bitch

I just got back from seeing my surgeon and even getting a fill. He added .5 mm. He was concerned how I told him that from the last time I got a fill (3 months ago) that the first week was perfect, then I got sick with the flu. I threw up for 3 days and then the restriction changed. His eyes perked up with concern from this. He mentioned the slight chance there could be some erosion. 


He proceeded with the fill. When I first had received fills they were difficult for him to hit the silicon entry point. I could feel him hitting the hard plastic portion of the port. As time went on and I was better healed it became easier for him. Well today, no such luck. I became a pin cushion once again. He fiddled around for 15-20 minutes just trying to hit the silicon area. He thinks as it has healed and formed to my muscle tissue that it is at a slight angle downward. I kept joking with him... as I am sweating and clammy from the nerves of him poking me... that what a pain in the ass it must be for him and that we should call my band "Little Bitch". He was definitely agreeing to this from day one.


I am to call back in 2 weeks to check in and tell him how I am feeling about my restriction. If there isn't any change in the right direction he will have me do my next fill under the Xray again and check for band erosion with drinking contrast dye. Did I mention I am allergic to that stuff? 


RED FLAG... What is Band Erosion?


Lap-Band erosion is migration of the band through the stomach wall into the stomach. This complication occurs in less than 2% of patients when surgeons use present day technique (pars flacida technique). It was significantly more common early on when the band was placed tightly against the stomach (peri-gastric technique).

Presentation. When the band erodes into the stomach, bacteria from the stomach enter into the capsule that mutually forms around the band. The infection then travels along the tubing into the pocket around the subcutaneous port. Thus many patients who develop erosion first notice pain, redness, and swelling in the vicinity of the access port. Another way that band migration presents is with loss of the band's restrictive effect. When the band erodes well into the stomach, food can bypass around the band. The patient can eat much more than before.

Diagnosis. Band erosion is best diagnosed with upper GI endoscopy. The endoscopist can actually see the band as it penetrates the stomach wall. IAn eroded band can also occasionally be identified on CT scan.

Treatment. Lap band erosion is usually not an emergency. If the access port site is infected, the port must be removed promptly. The band can then be removed semi- electively. Removal of an eroded band can be a difficult procedure requiring an open approach. Most surgeons simply remove the band and then perform rebanding, a gastric bypass, or duodenal switch as second procedure. Some surgeons have had success removing the band and performing a simultaneous rebanding or gastric bypass.