See Table 5.1. Laparoscopic adjustable gastric banding is an elective procedure almost exclusively used for treating morbid obesity. The procedure is often technically straightforward, if somewhat challenging, and the complication rate is often determined by the degree of obesity and coexistence of other underlying risk factors such as smoking, diabetes, pulmonary disease, and cardiovascular disease. The success in reducing obesity is well established, with the majority of patients maintaining >60 % excess weight loss (EWL) for 5 years or longer. Both the success and the complication rates are closely related to patient selection. Major problems include wound infection of port sites or the implanted reservoir, atelectasis and pneumonia, injury to other abdominal organs, conversion to open operation, venous thromboembolism, band erosion and slippage, stomal ulceration and bleeding, bolus obstruction or stomal stenosis, dysphagia, and inability to eat.

The major complications occurring after laparoscopic gastric banding are symmetrical pouch dilatation (more commonly in adolescents than adults), band slippage, and port complications (leakage, migration, tube kinking). Gastric erosion from the band is rare. Wound infection of port sites or implanted reservoir, chest infection, or intra-abdominal infection are relatively rare but can be serious. Gastric or esophageal perforation and leakage is very unusual and is usually diagnosed on routine contrast radiography on the first postoperative day. Systemic infection and multisystem organ failure may then ensue and is the major cause of mortality when it occurs. Possible conversion to open operation is important to warn the patient about. Bleeding is rarely severe and usually controlled at surgery. Failure of “stomal” function can occur. Occasionally mechanical obstruction needs to be excluded from edema, malpositioning, kinking, or insufficient stoma opening size due to cuff overinflation or symmetrical pouch dilatation patient overeating. Usually, improved function of the proximal pouch occurs after a period of weeks following band deflation and can be shown on subsequent contrast swallow. If it persists, however, laparoscopic repositioning or replacement of the band into a more proximal position is required. Bolus obstruction is not uncommon, with or without stomal stenosis, but usually responds to band deflation, but rarely may require endoscopy for removal of the bolus material. Stomal ulceration may occasionally cause bleeding. Erosion of the band material through the stomach wall is reported but is rarely serious, and the eroded band can be removed endoscopically, if the buckle lies intragastrically, or otherwise dealt with laparoscopically. Reservoir displacement or malfunction, tube kinkage, or leakage from the band or port may require revisional surgery. Splenectomy may be necessary from injury in <1 % of cases. Gas embolus or major vascular or bowel injury are additional serious, although very rare, complications of the laparoscopic approach. Venous thromboembolism is a serious and potentially lethal complication, which is related to obesity and surgery, but appears to be no more common in patients having laparoscopic band surgery than any other form of laparoscopic surgery.