Video case report Video case report: multiple intraperitoneal transections of Lap-Band tubing with descending colon inflammation: cause or effect? Jamie M. Rand, M.D.*, Jeremiah T. Martin, M.D., Geoffrey S. Nadzam, M.D., F.A.C.S. Department of Surgery, Hospital of St. Raphael, New Haven, Connecticut Received March 21, 2009; revised September 15, 2009; accepted September 15, 2009 Keywords: Bariatric surgery; Lap-Band; Laparoscopic adjustable gastric band; Morbid obesity; Complications We present the case of a patient with a rare complication of laparoscopic gastric banding. The patient presented with vague, left-sided abdominal pain 23 months after Lap-Band (Allergan, Irvine, CA) placement. Radiographic studies re- vealed complete disruption of the intraperitoneal Lap-Band tubing with descending colonic inflammation. Operative exploration revealed an abnormally stiff section of tubing with 1 complete transection and another partial disruption, neither of which were located at the connector site. One of the transected ends was lying in the proximity of the in- flamed colon. Additional tubing manipulation revealed it could easily be broken with a gentle bending force. Her pain resolved after laparoscopic tubing repair. Tubing breaks of this number in the intraperitoneal location (i.e., not in the subcutaneous or intramuscular positions or at the connector site) have not been previously described. Case report A 37-year-old woman had undergone laparoscopic Lap- Band placement in November 2006. By December 2007, she had lost 92% of her excess body weight after 2 band fills to 2 mL. In October 2008, she presented to her gastroen- terologist with complaints of vague left-sided abdominal pain, intermittent weight fluctuation, and a recent loss of restriction. Upper endoscopy revealed mild chronic gastri- tis. An abdomen/pelvis computed tomography scan re- vealed descending colon inflammation and intraperitoneal transection of the Lap-Band tubing (Fig. 1). The degree of inflammation seen on the computed tomography is sugges- tive of a process more than that of simple serosal irritation. The patient’s most recent Lap-Band fill in December 2007 was of the expected fluid volume. Her pain was worsening, and no new symptoms had developed. Specifically, she did not have any other signs or symptoms of colitis. Thus, she was scheduled for diagnostic laparoscopy and tubing repair. Preoperatively, she was counseled regarding the potential need for complete re- placement of the Lap-Band; however, she agreed only to repair of her current Lap-Band and was resistant to its removal or replacement. Laparoscopic exploration revealed that the Lap-Band tubing was completely transected at 1 location and was partially transected at another (Fig. 2) (Video 1 ). The end connected to the subcutaneous port was lying near the inflamed descending colon. The end connected to the intact Lap-Band was lying in the left upper quadrant. The 2 ends of the Lap-Band tubing were exteriorized through a port site in the patient’s left upper quadrant. During this process, the end attached to the Lap-Band broke at an addition location, again not at the connector site. The tubing was palpated, revealing an abnormally stiff segment that contained all the points of breakage. Because replacement of the Lap-Band was not an option, per the patient’s request, the abnormally stiff tubing was excised to grossly normal tubing, as determined by palpa- tion and pliability. These seemingly normal ends were spliced together using the silver metal connector from the Lap-Band repair kit. The repaired tubing was returned to the peritoneal cavity, insufflation was achieved, and the tubing was re-examined. It was intact without tension. She toler- ated the procedure without complications. Her left-sided *Reprint requests: Jamie M. Rand, M.D., 77 Nealy Ave., Langley AFB, VA 23665. E-mail: jamie.rand@langley.af.mil Surgery for Obesity and Related Diseases 5 (2009) 710 –712 1550-7289/09/$ – see front matter © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2009.09.008