Unexplaied jaundice

1. UNEXPLAINED JAUNDICE AFTER
ADJUSTMENTS IN A LAGB PATIENT:
REPORT OF A VERY RARE CASE
KONSTANTINOS KONSTANTINIDIS, SAVAS HIRIDES, PERIKLES CHRYSOHERIS,
FOTIS ANTONAKOPOULOS, PETROS HIRIDES
ATHENS MEDICAL CENTER, ATHENS, GREECE

2. Background
 Laparoscopic adjustable gastric banding (LAGB) has been a popular form of
weight loss in the past decades.
 There are a few reports of misplaced bands from inexperienced teams;
 found too high around the esophagus
 or in the ante-gastric position around the stomach,
 but also around the left liver lobe
 or other bizarre locations.

3.  A rare case of jaundice following adjustments in a LAGB
patient is presented in this paper.

4. Methods
 A 46-year old woman who underwent surgery for LAGB placement 7 months prior to
her visit to us,
 presented to our outpatient department with
 jaundice (bilirubin =3,6)
 associated with band adjustments.
 We aspirated 7cc from the band and proceeded with magnetic resonance and
computerized tomography,
 which to our surprise revealed an adjustable band misplaced around the
hepatoduodenal ligament.

5.  Immediately the patient was advised for surgical
removal of this band.

6. Approach
 A robotic approach was selected for better visualization and
dexterity of the instruments in the case of anticipated technical
difficulty.

7. Results
 Soon after creation of the pneumoperitoneum the band was found around the hepatoduodenal
ligament and the portal triad (hepatic artery, portal vein, common bile duct).
 A bougie was introduced to the stomach and the duodenum.
 Careful dissection around the band took place and the band was removed using monopolar
scissors and bipolar cautery carefully avoiding the right gastroepiploic vein after entrance to the
omental bursa.
 Following that, careful excision of the reactive capsule was performed.
 After completion of the procedure, the band and the capsule were removed through the incision
for the camera port.
 A no19 Jackson Pratt drain was put in place.

8.  Patient followed a normal postoperative course and was
discharged the following day with normalized bilirubin levels.

9. LAGB
Misplaced AGB
KM Konstantinidis et al. 2015

10. Conclusions
 Laparoscopic adjustable banding has been considered the safest
bariatric operation and probably for this reason many
inexperienced teams have tried to use it with variable results and
increased rates of complications.
 Experience of the operating team and surgical technique are of
extremely high importance for correct placement of the adjustable
gastric band.

11. THANK YOU FOR YOUR ATTENTION