Lap Band Leaks: What You Should Know
A Lapband leak is suspected when a patient that previously had adequate restriction feels a change in the amount of restriction. This can happen suddenly or over a period of time, depending on the size of the leak. If there is a leak of the lap band, the band will not be able to be adequately filled and will not provide restriction, or function properly. There are four types of lapband leaks that can occur to the lapband once it is placed, based on the location: (1) Leaks at the lapband balloon, (2) Leaks at the lapband tube connections, (3) Leaks at the body of the tube, and (4) Port membrane leaks.
(1) Leaks at the Lapband Balloon
Leaks in the lap band balloon can be unintentionally caused by needle punctures during surgery, or may occur over time in certain factory weak points of the balloon.
Leak in Lapband balloon
Figure 1.0 In the figure above, you can see the lap band (white rectangular shape), which has been filled with contrast fluid. The arrow points to a small amount of fluid that has moved outside the band from a small leak in the balloon of the lap band (VG).
Figure 1.1 This is another image of a lap band balloon leak. A thin line of contrast fluid can be seen outside of the lap band, surrounding both the band and the tube.
Figure 1.2 The lap band balloon can be seen in the centre of this image (rectangular shape, slanted to the left). In this case, there is a larger leak of contrast fluid which is more easily visible around the lap band balloon (arrow).
Lapband leak seen during surgery
Figure 1.3 In this case, there was a leak in the lap band balloon, and surgery was required to remove the band. During surgery, the leak was very clearly seen when fluid was pushed through the lap band, to reveal the location of the leak. (The arrow points to the line of fluid leaking from the AMI band).
(2) Leaks at the Lapband Tube Connection
Leaks can occur within the Lapband tube connection if there is a break or fracture of the tube next to the metal connector. Breaks or fractures may be due to physical movement over time, when considering the materials of the connections (metal and silicone). If the “fracture” is complete, it can be easily diagnosed with an x-ray film (plain film), without needing to inject contrast fluid.
Lapband plain film
Figure 2.0 Above, we can see the lapband port in the lower, right corner, with the tube extending to the left in the x-ray image. There is a complete fracture (break) in the tube. The distal end of the tube is near the port, which means the tube may still be in the abdominal wall.
Figure 2.1 Above, we can see the lapband port near the bottom of the x-ray image, with a complete fracture (break) in the tube, which is curled up at the top of the image. This shows that the tube is likely still inside the abdominal cavity.
Port of a Lapband leak
Figure 2.2 Above is a photo of the lapband port that was removed during surgery from Figure 2.1.
If the “fracture” is incomplete, it is necessary to inject contrast inside the system in order to diagnosis the problem.
Figure 2.3 This shows an incomplete fracture, with the tube in place.
Figure 2.4 This is the port removed from the above case (Figure 2.3).
Figure 2.5 In this plain x-ray film, the port can be seen in the bottom right corner. There is a slight bend in the tube at the connection point (upper right corner of the film).
Figure 2.6 As a leak was suspected, contrast fluid was passed through this lapband port. A large amount of contrast fluid is seen at the bend, in the top right (the connection point).
In some cases, it is not possible to indentify a leak with x-rays. Therefore, the diagnosis of a leak may need to be done at the time of surgery.
Figure 2.7 In this x-ray with contrast fluid, there is no evidence of a leak.
Tube leak near the port
Figure 2.8 This leak was not demonstrated with x-rays. As the leak was suspected, surgery was required to find the location of the leak.
(3) Leaks at the Body of the Tube
These lap band leaks are usually iatrogenic. This means that the leak was caused by an unintentional needle puncture, during a fill that was done without using fluoroscopy to guide the needle. These kinds of leaks are very common in office fills. Even in the best hands, there is always a risk of puncturing the tube during a lap band adjustment. This is one of the reasons that we always recommend fills to be done under fluoroscopy.
Lapband tube puncture
Figure 3.0 A leak can be seen in the body of the tube, close to the connection. This leak was made with a needle at the time of an adjustment (office fill).
Figure 3.1 The leaking portion of the tube was removed during surgery.
(4) Port Membrane Leaks
This type of leak usually occurs when the patient has received many fills, or when the adjustment was done using a standard needle. Only Huber (non-coring) needles (Figure 4.2) should be used to perform fills or adjustments. The silicone membrane of the port may be damaged if any other type of needle is used.
Figure 4.0 The lapband leak is just in front of the port, where contrast can be seen.
Port Membrane Leak
Figure 4.1 During surgery, we can see a leak at the port membrane as seen by the bubbles that are produced when the port is placed in water. Huber Needle
Figure 4.2 Huber (non-coring) needle.
Every day, the lap band manufacturers are improving the design and functionality of the gastric bands in order to prevent complications such as leaks. However, there is always a small risk of leaks over time. Many types of lap band leaks can be avoided by careful handelling the gastric band at the time of the surgery and by doing the lap band fill or adjustment under the fluoroscopy guide, and finally by using the right non-core needle.
Arturo Rodriguez, MD
Susana González, MD