Laparoscopic staged adjustable gastric banding and liver resection in morbidly obese patient

We report the case of a 34-year old morbidly obese female, with a history of polycystic ovarian syndrome and birth control pill therapy, who underwent laparoscopic gastric banding. On laparoscopic exploration, a 4-cm liver neoplasm that was missed by preoperative ultrasound was incidentally found. The intraoperative biopsy was suggestive for a benign lesion of hepatocellular origin but could not make the differential diagnosis between focal nodular hyperplasia and adenoma. The neoplasm had atypical features on postoperative magnetic resonance imaging and was suggestive of liver adenoma. Six months after laparoscopic gastric banding, the patient presented with a weight loss of 24 kg and consented to liver resection. A laparoscopic resection of liver segment 3 was performed. Atypical liver neoplasms are subject to potential degeneration, rupture, and bleeding; therefore, they should be treated surgically to allow final diagnosis and potential cure of the disease. In this case, a staged approach was effective in obtaining substantial weight loss and a lesser degree of liver steatosis to enable the performance of a laparoscopic liver resection.