Case Report Unveils New Long-Term Risk for Gastric Banding Surgery

All surgeries come with risks for post-operative complications. When choosing a surgery for Morbid Obesity, most Americans balance the pros and cons between the two most common – Laparoscopic Gastric Bypass and the Adjustable Gastric Band. While banding overall appears to have fewer potential complications because it is the least invasive of the two procedures, there are some serious long-term problems that should be considered.

The most common complications are related to the hardware itself which causes up to 18% of all problems. The band can cause erosion to the stomach, can puncture and leak, or may slip out of place causing a bigger pouch above the band. Esophageal dilation is another common complication which is usually the result of the band being too tight or being placed incorrectly.

Most of the time, the band does not cause respiratory distress, but British doctors have found a case of a 49-year-old woman in Dudley, England who first presented 20 months after gastric band placement with a chronic productive cough, night sweats, and general malaise. Although she was known to be asthmatic, treatment for exacerbation did not relieve her symptoms.

Dr. Adam Czapran MBChB of Russells Hall Hospital and colleagues conducted a series of tests, including tests for tuberculosis, before ultimately discovering that the band had been placed too tightly and caused persistent reflux of food into her airway. It was discovered that the woman had had additional fills after surgery because her weight loss was deemed only modest. While GERD (gastroesophageal reflux disease) is a common condition after gastric banding, it does not usually produce respiratory symptoms.

When the band was emptied, her symptoms, which included lung cavitation (the formation of cavities in the lung) in the upper left lobe and esophageal dilation, resolved.

Dr. Czapran cautions bariatric surgeons and other physicians to be alert to the possibility of gastric band malfunction in patients with pulmonary problems. "Given the increasing frequency of people undergoing interventional procedures to aid weight loss, recognition of the short-term and long-term complications is paramount," he writes in The Lancet. The doctor suggests that they have chest radiography and/or thoracic CT scans if they present with respiratory symptoms. Withdrawal of the band fluid should be done as soon as possible to relieve the obstruction.

The British woman ultimately had her band “cautiously refilled” and a year later she remained symptom-free. In addition, she had achieved a weight loss to a BMI of 34.8 kg/m2, down from 45.4 kg/m2 at the time of the original placement.

Source reference:
Czapran A, et al "Recurrent aspiration and upper lobe cavitation" Lancet 2011; DOI: 10.1016/S0140-6736(11)61517-1.

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