Infection with the Lapband
This is what a typical appearing port infection looks like.
Note that an infected band typically will present with a port site infection – as the port is in the subcutaneous tissue, and more prone to infection. An infection of the skin by the port warrants an endoscopy to rule out a band erosion.
It is common for a patients who have a Lap-band and present with a fever of unknown origin, or sepsis, to be told that the issue may be the band. This is highly unlikely.
The work up for this is to have the patient undergo endoscopy, because a primary infection from a band can only occur if the band is exposed to the bacteria of the stomach from an eroded band. If the band has not eroded into the stomach , then the source of infection lies elsewhere.
That band, however, will be at risk in the future for eroding into the stomach (or tubing has been reported to erode into the colon), because any systemic infection can colonize the band. At some point in the next few months that band should be removed.
The body’s response to the colonized band for the stomach to phagocytize the band leading to an erosion. It is much easier to remove a band while the patient has no erosion, but is at a high risk for erosion. The patient can have another band placed in six months, or opt for another bariatric procedure (gastric sleeve, RNY-gastric bypass, gastric plication, or duodenal switch).
A band that has eroded into the stomach can be a source of infection, but this has only been reported as a cause of local peritonitis, and not systemic infection. Upon exploration the eroded band has typically been walled off by the omentum.
Initial Placement of the band
The band itself is sterile, placed in the operating room in aseptic conditions, and into the peritoneum, also a sterile environment. A break in sterile technique can cause the band to be seeded with bacteria. This will present with a port site infection within a few days.
A band that is eroded requires removal by an experienced bariatric surgeon, and can be done with minimal morbidity and mortality, and done laparoscopically. General surgeon’s have been known to cause more damage, being unfamiliar with the device and how it is placed.