laparoscopic adjustable gastric banding ( lagb ) is an accepted and common procedure for morbid obesity . however , erosion of gastric wall is a recognized complication . in a systematic review by egberts et al . , the overall incidence was 1.46% at mean follow up of 3.7 years . upon detection of gastric band erosion , their immediate removal is highly advocated as their delay is associated with significant mortality and morbidity . these include total endoscopic ( endoluminal ) , laparoscopic , combined laparoscopic and endoscopic approach , and open surgery in complex cases . amongst them , the endoluminal approach is the least invasive of all ; however , this might not be feasible and applicable in some cases . when the anterior wall of the stomach is densely scared and there are some adhesions , and earlier techniques have failed to prevail , laparoscopic transgastric might be an effective technique if band can not be safely removed . herein , we report a successful removal of an eroding adjustable gastric band with its technical suggestion in a 43-year - old female patient 22 months following its application . a 43-year - old lady with a body mass index ( bmi ) of 40 with past medical history of hypertension had a lagb for morbid obesity 22 months ago . she presented to the emergency department with 3-day history of epigastrtic and shoulder pain . on examination her bmi was 31 and she was found to have a raised white cell count of 12.5  10 and c - reactive protein of 155.6 mg / dl . apart from albumin ( 27 g / l ) , no other serological and/or haematologic markers were found to be abnormal . 1 ) demonstrated no collection or contamination with localized gas loculation around the band ( fig . decision was made to remove the band endoscopically and the patient was taken to the operating theatre were endoscopy demonstrated gastric wall erosion . therefore , access to the abdominal cavity was obtained by placement of 3  10 mm ports ( right upper quadrant ( ruq ) , left upper quadrant ( luq ) , umbilical ) and 2  5 mm ports ( epigastrium and left upper quadrant ) . no free fluid and/or contamination was identified within the abdominal cavity . following the removal of the adhesions from the lesser curvature of the stomach and liver bed , gastrostomy was performed and two ports ( 10 mm and 5 mm ) were then pushed forward from abdominal cavity into the stomach . both ports were held in place by inflation of the non - traumatic balloon ends . the band was identified , divided and removed through one of the port sites ( fig . both gastrotomies were closed with 3/0 pds suture and stomach inflation test ( air leak test ) using endoscopy was negative . a postoperative gastrografin ( fig . figure 1:cross section ct image demonstration the site of the band with no collection ( red arrow ) . figure 2:ct image demonstrating the air loculation site next to the band ( red arrow ) . 
 figure 3:transgastric image of the gastric band and its retrieval . cross section ct image demonstration the site of the band with no collection ( red arrow ) . ct image demonstrating the air loculation site next to the band ( red arrow ) . laparoscopic gastric banding remains an effective technique for the treatment of morbid obesity and is a primary and preferred choice for different centres . the reported complications vary from port site infection to band migration , pouch dilatation and gastric erosion . amongst them , gastric wall erosion presents late ( 13 years ) and the current reported incidence is estimated 0.314% . erosion can occur as a consequence of gastric wall ischaemia either secondary to a tight band and/or chronicity ( pressure necrosis ) , peptic ulcer perforation , chronic inflammation due to contaminated device , binge eating and self - induced vomiting . in our reported case , patient did not suffer from any of the aforementioned factors apart from chronicity of the gastric band . the clinical presentation of gastric erosion is varied and but majority of individuals report abdominal pain , systematic inflammatory response ( raised inflammatory markers ) and in some advance cases perforation , sepsis and multi - organ failure . ct is another option , although such tool is more useful in detection of associated complications such as extend , site and type of perforation and/or contaminations . upon detection of erosion , removal remains the only option and should be performed promptly to avoid associated mortality and morbidity . the use of prophylactic antibiotics in such circumstance is not clear but in our centre we highly recommend their use upon suspicion of diagnosis . in case of band migration and/or erosion , endoscopic removal has shown promising results , although such technique is not always applicable and their open retrieval has been suggested and performed . another option is standard laparoscopic division and retrieval . although feasible and successful , this method does not always permit a comprehensive visualization , dissection and division . in our reported case , we encountered the aforementioned factors . therefore , the decision was made to create anterior gastrotomies ( extension of the port to stomach ) to facilitate full division , retrieval of the gastric band and assessment of the erosion and its repair if necessary through transgastric approach . the authors believe , such procedure is safe and feasible in circumstances when standard laparoscopic retrieval is not possible . placement of a new gastric band is usually delayed for a period of 3 months in such cases [ 3 , 5 ] . in the reported case , patient made an uneventful recovery and was discharged 3 days following the procedure . in conclusion , transgastric division and removal of gastric band is safe , feasible and a good alternative when standard approach is not feasible .
gastric banding is a popular method for the treatment of morbid obesity . amongst complications , 
 gastric erosion remains uncommon but could prove fatal . 
 multiple techniques , from open surgery to endoscopic and standard laparoscopic technique for their removal , have been previously detailed in the literature . 
 however , only a few reports have mentioned their total laparoscopic transgastric removal in the literature . 
 herein , we report a successful removal of an eroding gastric band with its technical suggestion in a 43-year - old female patient 22 months following its application .