SAQ 318 – Surgery – gastric band slippage on abdominal X-ray

Surgery – gastric band slippage on abdominal X-ray.

a. AXR finding

• The phi angle is significantly greater than normal, suggesting band slippage.
• The normal phi angle is usually about 4-58 degrees.
• The phi angle is formed by the long axis of the band and a vertical line through the spine.

b. Diagnosis

• Gastric band slippage.

c. Frequency

• Around 12%; it usually occurs after three months and this is a typical presentation.

d. Complications

• Food or fluid intolerance causing dehydration and related complications.
• Gastric necrosis or perforation.

e. Management

• Give analgesia and antiemetics; avoid prokinetics.
• Keep nil by mouth and give IV fluids for deficit plus maintenance.
• Aspirate the balloon to deflate it, usually about 5 mL.
• Refer to the surgical team for inpatient investigation and management.
• Further assessment may include contrast study or CT with oral contrast for perforation, and often endoscopy and/or laparoscopy.