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Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated?

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Abstract

Introduction

Esophageal dilation (ED) has been described as a long-term complication following laparoscopic adjustable gastric banding (LAGB) with an incidence of 0.5–50 %. The purpose of this study was to evaluate the effect of major ED on weight loss and find methods to diagnose ED and possible treatment strategies based on a classification.

Materials and methods

We performed a retrospective analysis of all patients undergoing LAGB between 2004 and 2008 in three community-based hospitals. ED was classified in four stages of dilation using gastrografin swallow. We report body mass index (BMI), failure rates and reoperations among these patients, with a mean follow-up period of 6.7 years.

Results

Nineteen (18.4 %) of 103 patients who underwent LAGB presented with esophageal dilation. Band deflation failed for all nine patients (8.7 %) with major ED. The mean BMI at LAGB (BMI 1), revision (BMI 2), and 1 year after conversion (BMI 3) were 45.9 ± 3.2, 42.8 ± 4.9 and 30.3 ± 5.5 kg/m2, respectively. No significant difference was found comparing BMI 1 and BMI 2 (p = 0,065, EWL1: 14.2 ± 21.7 kg/m2). In contrast, the weight loss after the revision surgery was significant (p = 0.001, EWL2: 67.1 ± 30 kg/m2). No significant difference was found concerning age, gender, ASA, preoperative (LAGB) weight, and mean interval between LAGB and revision comparing patients with major ED (IV) to patients with milder forms (ED I-III).

Conclusion

ED is a serious long-term complication after LAGB and seems to prevent effective weight loss in stage IV. Furthermore, untreated dilation could cause long-term damage to the esophagus. Therefore, we suggest routine radiographic follow-up after LAGB even in asymptomatic patients and a treatment based on a classification with an early surgical revision for major ED.

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Conflict of interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Tom Florian Ulmer, H. P. Alizai, A. Lambertz & U. Neumann

  2. Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, St. Remigius 26, 51397, Leverkusen, Germany

    Peter Ambe

  3. Department for Bariatric and Metabolic Surgery, St. Franziskus-Hospital Cologne, Schoensteinstrasse 63, 50825, Cologne, Germany

    K. Rheinwald & A. Plamper

  4. Department of General and Visceral Surgery, Johanniter Hospital Bonn, Johanniterstr. 3-5, 53113, Bonn, Germany

    M. Son & A. Tuerler

  5. Department of General and Visceral Surgery, Municipal Clinic Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany

    D. Gärtner

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  1. Tom Florian Ulmer
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  2. Peter Ambe
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  3. H. P. Alizai
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  9. D. Gärtner
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  10. U. Neumann
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Correspondence to Tom Florian Ulmer.

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Ulmer, T.F., Ambe, P., Alizai, H.P. et al. Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated?. World J Surg 39, 2000–2005 (2015). https://doi.org/10.1007/s00268-015-3036-2

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  • DOI: https://doi.org/10.1007/s00268-015-3036-2

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