Jejunal Obstruction After Complete Transmural Gastric Band Migration Florian Primavesi, MD, Tarkan Ja ¨ger, MD, Michael Baschata, MD, Dietmar O ¨ fner, MD, MAS, MSc, FACS Department of Surgery, Paracelsus Medical University, Salzburg, Austria (all authors). ABSTRACT Introduction: Surgery for morbid obesity is constantly gaining popularity around the world, and laparoscopic adjustable gastric banding is among the most accepted standard procedures. Lately, growing evidence for long-term complications has been reported with this particular technique. While band erosion is described in 1% of patients, complete transmural migration is scarce but may lead to acute intestinal obstruction. Case Description: We present the case of a 55-year-old man with the rare but potentially life-threatening late complication of a complete band migration and consecutive intestinal obstruction 12 years after laparoscopic adjustable gastric banding. Intraoperative findings showed ischemic pressure ulcers and kinking of a small bowel loop due to adhesions and the migrated band device; thus, partial jejunal resection was necessary. The development of a pronounced wound infection required prolonged ambulatory wound care, but ultimately there was no permanent morbidity. Discussion: Our report aims to raise awareness of possible long-term problems in bariatric surgery, especially after gastric banding. It demonstrates the importance of continuous supervision of obesity patients including regular assessments to avoid and detect complications even years after surgery. Key Words: Band migration, Laparoscopic gastric banding, Long-term complications, Morbid obesity, Small-bowel obstruction. INTRODUCTION Obesity and related comorbidities such as type II dia- betes and hypertension show an increasing prevalence. Several bariatric procedures have emerged, with adjust- able gastric banding being a reasonably safe and widely distributed treatment for this worldwide epidemic. 1 Band erosion occurs infrequently (1% 2–8 ), whereas jejunal obstruction due to a completely migrated band device is extremely rare. To the best of our knowledge, at present there are only 3 comparable cases available by a PubMed literature search. 2,9,10 We describe the case of a gastric band migration 12 years after implan- tation and 8 years after explantation of the port and catheter. Our report details interesting intraoperative findings and emphasizes the importance of periodic assessments for patients with a history of obesity surgery to avoid and detect long-term sequelae particularly after laparoscopic gastric banding. CASE REPORT A 55-year-old man had received a series of surgical inter- ventions for morbid obesity at one of our teaching hospi- Citation Primavesi F, Ja ¨ger T, Baschata M, O ¨ fner D. Jejunal obstruction after complete transmural gastric band migration. CRSLS e2014.00158. DOI: 10.4293/CRSLS.2014.00158. Copyright © 2014 SLS This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Acknowledgment: The authors thank Anton Poggio for his kind assistance with proofreading the manuscript. Contributions: Dr. Primavesi acquired and analyzed the patient data, wrote the manuscript, and reviewed the literature. Dr. Ja ¨ger reviewed the patient data and wrote the manuscript. Dr. Baschata wrote the manuscript, provided photographs, and reviewed the literature. Dr. O ¨ fner reviewed the literature and wrote the manuscript. Address correspondence to: Florian Primavesi, MD, Paracelsus Medical University, Department of Surgery, Mu ¨llner Hauptstrasse 48, 5020 Salzburg, Austria. Phone: +43(0)662 4482 51002, Fax: +43(0)662 4482 51008, E-mail: f.primavesi@salk.at 1 e2014.00158 CRSLS MIS Case Reports from SLS.org CASE REPORT