Gastric lesions in the excluded gastric segment undetected by endoscopy or radiography in patients status post vertical banded gastroplasty.

A patient had two surgical revisions and another patient had one surgical revision of a vertical banded gastroplasty because of intraoperative findings of gastric ulceration, incomplete penetration, and transmural penetration of the silicone band. Preoperative esophagogastroduodenoscopy in all three cases and an upper gastrointestinal series in two of the cases failed to demonstrate these lesions, because the lesions were located in the surgically excluded gastric segment. These reports demonstrate that a normal upper gastrointestinal series or panendoscopy in a patient after vertical banded gastroplasty does not exclude significant lesions in the endoscopically inaccessible, excluded gastric segment, and that it may be necessary to perform a laparotomy on a severely symptomatic patient even when an endoscopy is normal.