Case report and literature review of small bowel obstruction secondary to gastric band tubing

Introduction and Importance: Laparoscopic adjustable gastric banding (LAGB) is a surgical intervention for treating morbid obesity. It is not without its complications and, very rarely, can cause small bowel obstruction (SBO) from the gastric banding tubing interacting with the small bowel. Case Presentation: This case report showcases a rare SBO in a 45-year-old woman who underwent LAGB 5 years prior. Radiological evaluation by CT scan showed dilated proximal bowel loops with air-fluid levels and an abrupt change in caliber in the mid-abdomen, concerning for small bowel obstruction. The patient then underwent a diagnostic laparoscopy, which revealed gastric band tubing looping around the common channel, causing a SBO. The gastric band connection tubing was severed to resolve the obstruction. Clinical Discussion: SBO secondary to LAGB is a very rare complication. Literature review yielded 17 previous cases with various outcomes. Ten required removal of the gastric band tubing, four had the hernia reduced without removal of the tubing or gastric band, and three required bowel resection. When a patient presents with an SBO in the setting of a LAGB, it is important to consider the tubing as a possible cause of an internal hernia. Conclusion: While internal herniations represent a more common complication of Roux-en-Y Gastric Bypass in literature, bariatric surgeons should also consider it after a LAGB procedure.