Didziokaite Gabija, Poskus Tomas, Malakauskiene Laura, Ramasauskaite Diana
Faculty of Medicine, Vilnius University, M. K. Ciurlionio g. 21, 03101 Vilnius, Lithuania; Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania.
Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariskiu g. 2, 08661 Vilnius, Lithuania.
Int J Surg Case Rep. 2021 Dec;89:106640. doi: 10.1016/j.ijscr.2021.106640. Epub 2021 Nov 30.
Obesity is a major health problem. Obese women have an increased risk of pregnancy-related complications. Weight loss before conception is associated with improved fertility rates and pregnancy outcomes. Bariatric surgery (BS), such as laparoscopic adjustable gastric banding (LAGB), was a popular option for obese women planning pregnancy. However, long-term follow-up studies indicate high rate of failure and reoperations. The work has been reported in line with the SCARE 2020 criteria.
We present a case of a 41-years-old multigravida who was diagnosed with intragastric penetration of the gastric band on the 27th week. Diagnostic laparoscopy and intraoperative esophagogastroduodenoscopy were performed. Gastric band was not removed and no other surgical interventions were performed. The patient underwent a caesarean section on the 37th week, due to the remaining risk of repeated gastric-band-related complications.
The management of pregnancy following LAGB has not been well defined yet. Gastric band erosion with intragastric band migration is considered to be one of the most worrisome of all LAGB-related complications.
International treatment consensus for pregnancy after BS is still missing. This case illustrates a need for practitioner to maintain a high index of suspicion of gastric-band-related complications during pregnancy. Gastric-band-related complications during pregnancy are rare with only limited number of published reports. To our knowledge, this is the first reported intragastric penetration of the gastric band in a pregnant woman, which was managed without gastric band removal during pregnancy and which had a good outcome for both, the patient and her baby.
肥胖是一个主要的健康问题。肥胖女性发生与妊娠相关并发症的风险增加。受孕前减重与提高生育率及改善妊娠结局相关。减重手术（BS），如腹腔镜可调节胃束带术（LAGB），曾是计划怀孕的肥胖女性的一个常用选择。然而，长期随访研究表明其失败率和再次手术率很高。本研究已按照SCARE 2020标准进行报告。
我们报告一例41岁经产妇，在孕27周时被诊断为胃束带胃内穿透。进行了诊断性腹腔镜检查和术中食管胃十二指肠镜检查。未移除胃束带，也未进行其他手术干预。由于仍存在与胃束带相关并发症复发的风险，患者在孕37周时接受了剖宫产。
LAGB术后妊娠的管理尚未明确界定。胃束带侵蚀伴胃内束带移位被认为是所有与LAGB相关并发症中最令人担忧的并发症之一。
BS术后妊娠的国际治疗共识仍然缺失。本病例表明，从业者在孕期需要对与胃束带相关的并发症保持高度怀疑。孕期与胃束带相关的并发症很少见且仅有数量有限的已发表报告。据我们所知，这是首例报道的孕妇胃束带胃内穿透病例，该病例在孕期未移除胃束带，患者和胎儿均获得了良好结局。
