Aorta, the Innocent Bystander of Bariatric Banding

Laparoscopic gastric banding (LAGB) is a common bariatric operation performed for obesity. Complications of LAGB commonly evolve around device malfunction and physiological changes secondary to the gastric banding. Complications of LAGB involving the aorta are rare. A case of gastric band misplacement around the aorta and subsequent successful retrieval of the misplaced device is reported.

A 45 year old obese woman presented as an emergency with food bolus obstruction secondary to gastric banding inserted 10 years previously. Investigations revealed that her gastric band was misplaced around both the oesophagus at the level of the gastro-oesophageal junction and the descending thoracic aorta at the level of T12. Successful and safe retrieval of the misplaced device is reported electively via a two staged approach: first covering the segment of supra-coeliac aorta at the level of the gastric band with a thoracic aortic stent graft (TAG), and, second, assessing for any oesophageal injury via endoscopy and finally extracting the misplaced device via laparoscopy. A Gore C-TAG device size 26 mm × 100 mm was successfully implanted percutaneously via unilateral femoral access during her first stage procedure. Her gastric band was safely retrieved during her second stage procedure with no complications. She recovered well post-operatively.

Complications of LAGB involving the aorta are rare but potentially life threatening. Multidisciplinary pre-operative planning is necessary for safe removal of the gastric band.