Late presentation of a diaphragmatic hernia following laparoscopic gastric banding.

Laparoscopic gastric banding is an established and increasingly popular surgical treatment for morbid obesity. Iatrogenic diaphragmatic injury can complicate upper abdominal and esophageal surgery. We describe here the case of a patient who had undergone revisional surgery to replace a laparoscopic band, who presented acutely, years following surgery, with breathlessness and abdominal pain. CT of the chest and abdomen demonstrated small bowel loops in the left chest and significant mediastinal shift. The patient required an emergency laparotomy to reduce the small bowel contents from the chest and repair the hernial defect. The small bowel contained within the hernia was ischemic though did not require resection. The patient made a prompt recovery. Iatrogenic diaphragmatic injury is a rare, though potentially life-threatening, complication of laparoscopic gastric band placement.